Retrograde cerebral perfusion for aortic arch surgery: analysis of risk factors

Ueda, Yuichi; Okita, Yutaka; Aomi, Shigeyuki; Koyanagi, Hitoshi; Takamoto, Shinichi

doi:10.1016/s0003-4975(99)00415-4

Cited by 101 publications

(45 citation statements)

References 10 publications

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“…With the improvement of cerebral protection methods including retrograde cerebral perfusion, 16) the outcome of TAR has been significantly improved. SCP prevents ischemic damage to the brain during circulatory arrest, so it facilitates complicated aortic arch replacement, resulting in a significant reduction of mortality and morbidity for aortic arch repair.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Nakamura

Yano

et al. 2011

ATCS

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Objectives: The present study was undertaken to identify risk factors for permanent neurological dysfunction (PND) and in-hospital mortality after total aortic arch replacement (TAR) with separate arch vessel grafting using selective cerebral perfusion (SCP) and hypothermic circulatory arrest. Methods: Between 1998 and 2008, we preformed a TAR on 143 consecutive patients in two centers by identical methods. Of these, 19 (13.3%) were emergency operations, and 46 (32.2%) were open stent-graft placements. Statistical analysis was performed to determine risk factors for PND and mortality, and furthermore, the survival rate was analyzed. Results: The in-hospital mortality rate was 4.9%, with chronic renal failure (p = 0.0013, odds ratio 10.0) as a significant risk factor. Nine patients (6.3%) had PND, with significant risk factors identified as (1) the presence of an old cerebral or silent lacunar infarction on preoperative imaging methods ( p = 0.0458, odds ratio 8.0) and (2) duration of SCP ( p = 0.0026, odds ratio 1.036). Long-term survival was the same in patients with or without PND. Conclusion: The enhanced vulnerability of the brain in patients with a pre-existing old cerebral infarction or silent lacunar infarction is reflected by a high incidence of PND. Chronic renal failure had an impact on in-hospital mortality.

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Section: Discussionmentioning

confidence: 99%

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Nakamura

Yano

et al. 2011

ATCS

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“…Although operative mortality has decreased, operative morbidity is still a matter of concern [1][2][3][4][5]. Stroke is the most severe complication of aortic arch repair [6][7][8].…”

Section: Discussionmentioning

confidence: 99%

“…The number of aortic surgeries has recently increased, with improvement of outcome due to the development of operative techniques, adjuncts, and postoperative care [1][2][3][4][5]. Although the mortality rate of aortic arch repair has recently decreased, the occurrence of stroke, the most severe complication of this type of surgery, is still a matter of concern [6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Multivariate analysis of predictors of late stroke after total aortic arch repair

Matsuura

Ogino

Matsuda

et al. 2005

European Journal of Cardio-Thoracic Surgery

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Objective: The number of aortic surgeries has recently increased, with improvement of outcome due to the development of various novel operative techniques and adjuncts. Although the postoperative incidence of stroke, the most severe complication of aortic surgery, is still a matter of concern and has been described well previously, late stroke after aortic arch repair has not been described well. We assessed the incidence and predictors of late stroke after total aortic arch repair. Methods: From January 1993 to December 2003, 470 patients underwent total aortic arch repair in our institution. All patients, whether undergoing elective, urgent, or emergent aortic arch repair, were included. Emergent operation was required for 115 patients because of rupture or acute type A dissection. For brain protection, retrograde cerebral perfusion was used in 27% (125) and selective cerebral perfusion in 75% (353) of cases. The follow-up period was 32.5G31.5 months. Late stroke was defined as stroke occurring more than 30 days postoperatively. Results: The incidence of early postoperative stroke was 4.9% (23/470), while that of late postoperative stroke was 6.0% (28/470). On univariate analysis, postoperative atrial fibrillation (PZ0.014), preoperative prevalence of craniocervical lesions (PZ0.0001), and advanced age (PZ0.046) were each significantly related to late stroke. A Cox proportional hazards model detected postoperative atrial fibrillation (PZ0.013, ORZ3.02, 95% CI: 1.26-7.24) and preoperative prevalence of craniocervical lesions (PZ0.0001, ORZ5.37, 95% CI: 2.30-12.52) as predictors of late stroke. Conclusions: Postoperative atrial fibrillation and preoperative prevalence of craniocervical lesions were found to be risk factors for late stroke after total aortic arch repair.

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“…Several techniques, including deep hypothermia with total circulatory arrest (DHTCA) [2][3][4], unilateral or bilateral selective antegrade cerebral perfusion (SACP) [5][6][7], and retrograde cerebral perfusion (RCP) through superior vena cava [8][9][10] have been used to protect the central nervous system. Each one of these techniques presents advantages and disadvantages and their different cannulation forms have recently been revised by Dias et al [11].…”

Section: Introductionmentioning

confidence: 99%

Cirurgia do arco aórtico com perfusão cerebral bilateral pelo isolamento do tronco braquiocefálico e da artéria carótida esquerda

Carreira

Oliveira²,

Honório

et al. 2008

Rev Bras Cir Cardiovasc

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Retrograde cerebral perfusion for aortic arch surgery: analysis of risk factors

Cited by 101 publications

References 10 publications

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Factors Influencing Permanent Neurologic Dysfunction and Mortality after Total Arch Replacement with Separate Arch Vessel Grafting Using Selective Cerebral Perfusion

Multivariate analysis of predictors of late stroke after total aortic arch repair

Cirurgia do arco aórtico com perfusão cerebral bilateral pelo isolamento do tronco braquiocefálico e da artéria carótida esquerda

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