Surgical Treatment of Aneurysms of the Thoracic Aorta with the Aid of Partial Cardiopulmonary Bypass: An Analysis of 95 Patients

Kazui, Teruhisa; Komatsu, S; Yokoyama, Hideo

doi:10.1016/s0003-4975(10)60234-2

Cited by 50 publications

(17 citation statements)

References 13 publications

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“…Despite the measures for preventing spinal cord ischemia, Kazui et al 9 and Coselli and LeMaire 4 reported that patients treated with left bypass had a lower incidence of paraplegia. Coselli and LeMaire reported a 6% incidence.…”

Section: Discussionmentioning

confidence: 99%

Correção dos aneurismas da aorta torácica e toracoabdominal: técnica de canulação central

Rojas¹,

Veiga²,

Souza³

et al. 2005

Arq. Bras. Cardiol.

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Section: Discussionmentioning

confidence: 99%

Correção dos aneurismas da aorta torácica e toracoabdominal: técnica de canulação central

Rojas¹,

Veiga²,

Souza³

et al. 2005

Arq. Bras. Cardiol.

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“…Mild hypothermia of approximately 32 C is also widely used in conjunction with distal perfusion of partial CPB [50,[62][63][64][65][66] at a distal pressure of more than 60 mmHg, because the spinal cord perfusion might be insufficient in these settings. MEPs are used perioperatively to monitor spinal cord ischemia continuously.…”

Section: Spinal Cord Protection During Aortic Surgerymentioning

confidence: 99%

“…The aneurysm is approached through a left thoracic or thoracoabdominal incision. During aortic cross-clamping, distal aortic perfusion is maintained by a partial CPB, consisting of a femoro-femoral circuit with mild hypothermia at 32 C [50,[62][63][64][65][66]. Anastomoses are performed using a segmental (sequential) clamp technique to reduce spinal ischemic time [64,81].…”

Section: Spinal Cord Protection During Aortic Surgerymentioning

confidence: 99%

Cardiovascular Surgical Technique Under Cardiopulmonary Bypass and Cerebrospinal Protection

Ogino

2015

Neuroanesthesia and Cerebrospinal Protection

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Brain and spinal cord injuries are some of the most troublesome sequelae during perioperative periods of cardiovascular surgery, which decrease the patient quality of life in the long term and can subsequently lead to serious morbidity and mortality. In cardiac surgery, one cause of perioperative cerebral complications is cardiopulmonary bypass (CPB). Off-pump coronary artery bypass grafting, particularly with a non-touch aortic technique, has been developed for preventing cerebral deficits. Other crucial issues are intraoperative examination of the ascending aorta with epiaortic echo and appropriate selection of alternative CPB cannulation sites such as the axillary or femoral arteries. On the other hand, in a variety of recently advanced endovascular aortic repair techniques, protection of the central nervous system is of greater concern, because the perfusion vessels of the brain, spinal cord, or both are involved in the surgical repairs. Hypothermia is still the underlying principle for cerebrospinal protection methods, because of the increased safety margin for preventing ischemic injury. Based on mild to moderate hypothermia, several kinds of antegrade and retrograde perfusion modalities are used for more secure protection. However, since they do not always provide complete cerebrospinal protection, several technical or pharmacological adjuncts should be added. These include precise preoperative examination of aortic and arterial lesions including identification of the Adamkiewicz artery, perioperative neuromonitoring with regional cerebral oxygenation and motor-evoked potentials, and various pharmacological methods.

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“…Detrimental effects of prolonged CPB, including heparin-related bleeding, cannot be ignored. 65 The distal perfusion technique is usually used in conjunction with other adjunctive measures such as CSF drainage or hypothermia. In situations where there is an absence of a well-developed collateral circulation, as in the case of traumatic aortic injury, the role of distal aortic perfusion in preserving neurological function is more obvious.…”

Section: Partial Cardiopulmonary Bypassmentioning

confidence: 99%

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

Okita

2011

Gen Thorac Cardiovasc Surg

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Paraplegia or paraparesis after otherwise successful thoracic or thoracoabdominal aortic reconstruction is a devastating complication for both patient and physician. Various strategies have been developed to minimize the incidence of neurological complications after aortic surgery. The incidence of spinal cord ischemia and subsequent neurological complications has been correlated with (1) the duration and severity of ischemia, (2) failure to establish a spinal cord blood supply, and (3) reperfusion injury. Preoperative identification of the arteria radicularis magna, the artery of Adamkiewicz, facilitates identification of critical intercostal vessels for reimplantation, resulting in reestablishing spinal cord blood flow. Techniques for monitoring spinal cord function using evoked potentials have been developed, and surgical techniques have evolved to reduce the duration of ischemia. Furthermore, sequentially sacrificing all the intercostal arteries while maintaining collateral circulation to the cord has produced good outcomes. The severity of ischemia can be minimized by using cerebrospinal fluid drainage, hypothermia, distal bypass, managing the blood pressure, and adjunctive pharmacological therapy. Reperfusion injury can be reduced with the use of antioxidant therapy. Recent advances in endovascular stentgrafting have reduced the incidence of postoperative spinal complications, especially among high-risk patients.

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Surgical Treatment of Aneurysms of the Thoracic Aorta with the Aid of Partial Cardiopulmonary Bypass: An Analysis of 95 Patients

Cited by 50 publications

References 13 publications

Correção dos aneurismas da aorta torácica e toracoabdominal: técnica de canulação central

Correção dos aneurismas da aorta torácica e toracoabdominal: técnica de canulação central

Cardiovascular Surgical Technique Under Cardiopulmonary Bypass and Cerebrospinal Protection

Fighting spinal cord complication during surgery for thoracoabdominal aortic disease

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