Selective cerebral perfusion during operation for aneurysms of the aortic arch: A reassessment

Kazui, Teruhisa; Inoue, Norio; Yamada, Osamu; Komatsu, S

doi:10.1016/0003-4975(92)90767-x

Cited by 176 publications

(105 citation statements)

References 17 publications

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“…The indications for emergent aortic arch surgery are: acute aortic dissection located within the arch, aortic rupture, false aneurysm, and impending dissection (penetrating aortic ulcer and intramural haematoma). Development of aortic arch surgery techniques was possible due to improvement of protection and monitoring of the central nervous system (CNS) [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

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Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

et al. 2016

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A b s t r a c tBackground: Surgery of the aortic arch is challenging. Aim:To assess the results of aortic arch surgery. Methods:Analysis of 172 patients operated on arch dissection (emergency group: 97 patients) or aneurysm (elective group: 75 patients) between 2007 and 2014. Arch surgery was defined as a procedure requiring circumferential anastomosis at the level of the aortic arch or the descending aorta with the use of techniques of brain protection (deep hypothermic circulatory arrest [DHCA] or selective antegrade cerebral perfusion [SACP]) and/or debranching of at least one supra-aortic vessel.Results: Men predominated in both groups (> 70%). Men were younger in the emergency group (55 vs. 66 years; p < 0.008). The operative risk was higher in the emergency group (19.2% vs. 12.5%; p < 0.001). Forty-nine per cent of the patients from the emergency group and 5% from the elective group were operated with antiplatelet therapy (p < 0.001). Extended hemiarch procedure was performed in 79% (n = 77) in the emergency and 76% (n = 57) in the elective group. Total arch replacement was performed in 19 (21%) patients from the emergency and 18 (24%) patients from the elective group. In these patients debranching was performed in 68% of the emergency patients group and in 67% of the elective group. Elephant trunk procedure (classic/frozen) was performed in 53% (n = 10) from the emergency and in 78% (n = 14) of patients from the elective group. Aortic valve sparing surgery was performed in 20% of patients from the emergency and 9% from the elective group (p = 0.063). DHCA was performed in 58% (n = 43) of patients from the elective group and 39% (n = 37) from the emergency group. SACP was performed in 61% (n = 58) of patients from the emergency and 42% (n = 31) from the elective group. Thirty-day mortality in the emergency group reached 33% (n = 32), and in the elective group 15% (n = 11; p = 0.007). In multivariate analysis, predictors of death in the emergency group were: Logistic EuroSCORE above 19.5%, extracorporeal circulation time above 228 min, and postoperative acute renal failure (ARF); and in the elective group: DHCA time above 26 min, rethoracotomy due to bleeding, and ARF. Follow-up was completed in 100% of patients in terms of vital status. The mean follow-up time of the patients from the emergency group was 24.3 ± 27.10 (min 0, max 92) months, and from the elective group 30.3 ± 24.5 (min 0, max 99) months. During the follow-up period all-cause mortality in the emergency group was 43% (n = 42/97), and in the elective group it was 36% (n = 27/75). Conclusions:Early mortality in the emergency group was higher, while long-term mortality did not differ among the groups. Postoperative ARF is a critical predictor of mortality in both groups.

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Section: Introductionmentioning

confidence: 99%

“…Since brain tissue is the least resistant to anoxia, new methods have been found to complement DHCA [9]. Retrograde cerebral perfusion and selective antegrade cerebral perfusion (SACP) provide blood flow through CNS during circulatory arrest [5].…”

Section: Introductionmentioning

confidence: 99%

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

et al. 2016

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“…A short time later, in Japan, Kazui et al described a similar method but in which the core and perfusate temperatures are the same resulting in a simplified circuit (26). Because of its greater simplicity, this method has become presently the most popular and used one.…”

Section: The Cerebral Protectionmentioning

confidence: 99%

Open repair techniques in the aortic arch are still superior

Bachet¹

2018

Ann. Cardiothorac. Surg.

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Conventional arch replacement can be carried out in a great majority of patients. Hybrid procedures are often as invasive and technically difficult as conventional ones. Moreover, their immediate results are, in many reported experiences, not better and their long-term results less favourable than the ones observed with conventional methods. So, yes, the open conventional arch replacement is still "the gold standard".

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“…Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. The best method to protect the brain has demonstrated to be the bilateral antegrade selective cerebral perfusion (ASCP) with moderate hypothermia according to Kazui's technique (25). In fact, very favorable outcomes are reported in literature, indicating ASCP is the best method to protect the brain, especially when time consuming and complex arch repairs are required (26).…”

Section: Technique Of Aortic Arch Replacementmentioning

confidence: 99%

When and how to replace the aortic arch for type A dissection

Bartolomeo

Leone

Marco

et al. 2016

Ann. Cardiothorac. Surg.

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Acute type A aortic dissection (AAAD) remains one of the most challenging diseases in cardiothoracic surgery and despite numerous innovations in medical and surgical management, early mortality remains high.The standard treatment of AAAD requires emergency surgery of the proximal aorta, preventing rupture and consequent cardiac tamponade. Resection of the primary intimal tear and repair of the aortic root and aortic valve are well-established surgical principles. However, the dissection in the aortic arch and descending untreated aorta remains. This injury is associated with the risk of subsequent false lumen dilatation potentially progressing to rupture, true lumen compression and distal malperfusion. Additionally, the dilatation of the aortic arch, the presence of a tear and retrograde dissection can all be considered indication for a total arch replacement in AAAD. In such cases a more aggressive strategy may be used, from the classic aortic arch operation to a single stage frozen elephant trunk (FET) technique or a two-stage approach such as the classical elephant trunk (ET) or the recent Lupiae technique. Although these are all feasible solutions, they are also complex and time demanding techniques requiring experience and expertise, with an in the length of cardiopulmonary bypass and both myocardial and visceral ischemia. Effective methods of cerebral, myocardial as well visceral protection are necessary to obtain acceptable results in terms of hospital mortality and morbidity. Moreover, a correct assessment of the anatomy of the dissection, through the preoperative angio CT scan, in addition to the clinical condition of the patients, remain the decision points for the best arch repair strategy to use in AAAD.

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Selective cerebral perfusion during operation for aneurysms of the aortic arch: A reassessment

Cited by 176 publications

References 17 publications

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

Single-centre experience in surgery of acute aortic type A dissection and true aortic arch aneurysm

Open repair techniques in the aortic arch are still superior

When and how to replace the aortic arch for type A dissection

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