Selective cerebral perfusion with aortic cannulation and short-term hypothermic circulatory arrest in aortic arch reconstruction

Türköz, Rıza; Sarıtaş, Bülent; Özker, Emre; Vuran, Can; Yörüker, Uygar; Balci, Sule Turgut; Altun, Dilek; Türköz, Ayda

doi:10.1177/0267659113496581

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…9,25 A so-called "beating heart and brain" technique is widely used at present in many centers for either isolated hypoplastic aortic arch repair or complex heart anomalies with aortic arch obstruction. 10,12,[26][27][28] In terms of the DAC method, it seems to be even more effective when adding myocardial perfusion and maintaining "total body perfusion"; however, it could be technically demanding and require a larger area at the surgical field, which may impede operative manipulations.…”

Section: Discussionmentioning

confidence: 99%

“…[4][5][6] However, there are studies suggesting that selective antegrade cerebral perfusion (SACP) may not be more effective compared to deep hypothermic circulatory arrest (DHCA) in terms of preserving renal function or reducing adverse neurological outcomes. 7,8 Selective antegrade cerebral perfusion has the option to be used with [9][10][11][12] Continuous lower body perfusion with additional descending aortic cannulation (DAC) has gained much attention as a method of visceral protection during aortic arch reconstruction. 13 Only a few studies have described the effectiveness of this method in the last decade with promising outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants

Kulyabin¹,

Gorbatykh²,

Soynov³

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Aortic arch reconstruction is often challenging, especially in infants, owing to its high postoperative complication risks. This study aimed to compare the effectiveness between selective antegrade cerebral perfusion (SACP) alone and SACP in combination with continuous lower body perfusion with descending aortic cannulation (DAC) in preserving renal function, and to determine the influence of perfusion strategy on the postoperative course of infants who underwent aortic arch reconstruction. Material and Methods: A total of 121 infants who underwent aortic arch reconstruction between January 2008 and December 2018 were included in the analysis. Patients (median age: 29 days, range: 3-270 days) were divided into the following groups: those who underwent repair with SACP (SACP group, 79 patients) and those who underwent additional lower body perfusion (DAC group, 42 patients). Results: Three (7.1%) and nine (11.4%) patients died in the DAC and SACP groups, respectively ( P = .54). The SACP group had more patients requiring renal replacement therapy ( P = .002) and higher incidence of second stage acute kidney injury (AKI) development (Kidney disease improving global outcomes (KDIGO) criteria; P = .032). The SACP group had higher frequency of open chest postoperatively than the DAC group ( P = .011). The DAC group had lower vasoactive inotropic score (VIS) at the first postoperative day ( P < .001) and shorter intensive care unit length of stay ( P = .050). There was no difference in neurological complications between the groups ( P = .061). High VIS was associated with early mortality (odds ratio [OR]: 1.79 [1.33-2.41], P < .001) and AKI (OR: 1.60 [1.35-1.91], P < .001). The DAC perfusion strategy with minimal hypothermia was associated with lower risk of AKI (OR: 0.91 [0.84-0.98], P = .016). Conclusion: Antegrade cerebral perfusion with continuous lower body perfusion via DAC could effectively be used for improving early postoperative results among infants undergoing procedures that include aortic arch reconstruction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants

Kulyabin¹,

Gorbatykh²,

Soynov³

et al. 2019

World J Pediatr Congenit Heart Surg

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“…Turkoz and colleagues enrolled 37 neonates and infants to arch construction in the presence of selective cerebral and myocardial perfusion and short-term total circulatory arrest. They concluded that continuous perfusion every 10 minutes was safe and practical in these patients [13]. In a randomized trial on neonates, Newburger and coworkers compared deep hypothermia with total circulatory arrest to deep hypothermia with low-flow cardiopulmonary bypass.…”

Section: Discussionmentioning

confidence: 99%

Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

Fouly

2019

Egypt. Cardiothoracic. Surg.

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IntroductionDeep hypothermic circulatory arrest (DHCA) is a surgical technique that aims to protect the brain during cardiac and aortic surgeries. It was established in the 1950s and promoted in the 1970s [1]. The main principle of this technique is to reduce brain metabolism by cooling the body below 18C, allowing for more extended periods of interrupted blood flow [2]. The metabolism rates decrease by about 7% for every 1°C drop below 37°C [3,4]. Moreover, when the body temperature reaches 20°C, oxygen consumption is reduced to 20% of normothermic values [5]. AbstractBackground: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

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“…Compared to the traditional surgical treatment, the hybrid procedure has many advantages (11). For example, because it requires less cross clamp time and bypass time, possible cerebral dysfunction due to DHCA or low circulatory flow can be avoided (12). In addition, the patients may experience a quicker recovery from mechanical ventilation in the intensive care unit.…”

Section: Discussionmentioning

confidence: 99%

A comparison of balloon angioplasty of native coarctation versus surgical repair for short segment coarctation associated with ventricular septal defect—a single-center retrospective review of 92 cases

Zhang

Chen

et al. 2016

J. Thorac. Dis.

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Selective cerebral perfusion with aortic cannulation and short-term hypothermic circulatory arrest in aortic arch reconstruction

Abstract: SCMP with aortic cannulation and short TCA (under 10 minutes) in aortic reconstruction is safe and practical in this high-risk patient group.

Cited by 4 publications

References 22 publications

Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants

Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants

Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

A comparison of balloon angioplasty of native coarctation versus surgical repair for short segment coarctation associated with ventricular septal defect—a single-center retrospective review of 92 cases

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