The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: A propensity score analysis

Kamiya, Hajime; Hagl, Christian; Kropivnitskaya, Irina; Böthig, Dietmar; Kallenbach, Klaus; Khaladj, Nawid; Martens, Andreas; Haverich, Axel; Kretzler, Matthias

doi:10.1016/j.jtcvs.2006.09.045

Cited by 221 publications

(195 citation statements)

References 15 publications

(28 reference statements)

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“…In 2007 Kamiya published a greater tendency towards the appearance of paraplegia with MH in the subgroup of patients with CA over 60 minutes (29). Similar data had already been found in experimental animal studies where it was found that at 28 ℃ there were up to 60% paraplegia when the PCT was greater than 90 minutes (30).…”

Section: Dh Vs Moderatesupporting

confidence: 54%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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Section: Dh Vs Moderatesupporting

confidence: 54%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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“…With ACP, hypothermic circulatory arrest temperature up to 28°C can be increased for safe aortic arch repair for 60 min or less. 16) As to prolonged duration up to 60 min for circulatory arrest under same situation, they could not answer it.…”

Section: Discussionmentioning

confidence: 98%

Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

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IntroductionType A acute aortic dissection (AAD) is still a devastating disease, which mortality rate following medical managements reaches to 50% within the first 48 h. 1) The mortality rate associated with AAD after surgery has decreased, but it reached to roughly 20% worldwide. 2) In Japan, hospital mortality rate after an emergency surgery for AAD was 9.2% in 2010. 3) Antegrade cerebral perfusion (ACP) is one of the techniques for cerebral protection during proximal aortic surgery. This technique has been applied to a repair of AAD and effective circulation management could be achieved by Comas et al. 2) Controversy that which arterial cannulation site is optimal in a repair of AAD exists. 4,5) Femoral artery is the usual cannulation site for cardiopulmonary bypass in a repair of AAD, 6) on the other hand, the retrograde perfusion via the femoral artery causes retrograde thromboembolism from atheromatous debris in the thoracic and was performed in 34 patients. Mean age was 64.5 ± 13.7 years of age. Preoperative shock status was in three due to cardiac tamponade. Organ malperfusion occurred in 11 patients preoperatively. Mean follow-up period was 9.6 ± 8.4 months and follow-up rate was 100%. Results: Hospital mortality rate was 8.8%. No newly required hemodialysis and new onset of temporary or permanent neurologic deficits were present in survivors. There were no statistically significant differences of mortality rate, new onset of permanent or temporary neurologic deficits and distal organ dysfunction between ACP duration <60 min and ≥60 min. The 12-month survival was 84.4% ± 6.4%. And, freedom from aorta-related events at 12 and 18 months were 100% ± 0.0% and 88.9% ± 10.5%, respectively. Conclusions: The duration of ACP via right axillary artery does not affect early outcomes following a repair of AAD.

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“…did not find any significant differences in mortality and morbidity; they only observed a trend towards a lower post-operative inflammatory response and reduced re-exploration for bleeding in the second group. 18 Strauch et al has asserted that brain oxygen consumption drops down to 50% of baseline value with moderate hypothermia (28°C) and that further cooling does not decrease brain oxygen consumption effectively. 19 Moreover our series showed that deep HCA was a significant predictor of PND, NE and EM and that it did not seem to be a protective factor in the follow-up on neurocognitive impairment.…”

Section: Discussionmentioning

confidence: 99%