Advantages of subclavian artery perfusion for repair of acute type A dissection*1

Reuthebuch, Oliver; Schurr, Ulrich; Hellermann, Jens; PretrePrêtre, René; KunzliKünzli, Andreas; Lachat, Mario; Turina, Marko

doi:10.1016/j.ejcts.2004.04.032

Cited by 76 publications

(58 citation statements)

References 14 publications

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“…Perfusion pressures should usually be 40 to 70 mm Hg, and flow rates should be 10 mL ⅐ kg Ϫ1 ⅐ min Ϫ1 or approximately 1000 mL/min, regardless of the ACP technique used. [7][8][9][15][16][17] In our survey, most surgeons aimed for or even exceeded these values. We detected a substantially reduced risk for PNDmc at perfusion pressures that exceeded 60 mm Hg and a mild risk reduction at flow rates that exceeded 600 mL/min.…”

Section: Cerebral Perfusionmentioning

confidence: 98%

“…7,9 Disregarding cerebral perfusion, axillary artery cannulation also confers antegrade aortic perfusion from the beginning of CPB and has been shown to be superior to femoral cannulation in AADA patients. 17 Which ACP strategy is the best for cerebral protection remains uncertain. Larger studies comparing uACP to bACP have generated inconsistent results, 7,24 and we detected no relevant differences relating to outcomes.…”

Section: Differences In Cerebral Protection Strategiesmentioning

confidence: 99%

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Cerebral Protection During Surgery for Acute Aortic Dissection Type A

et al. 2011

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on behalf of the GERAADA Investigators Background-Cerebral protection during surgery for acute aortic dissection type A relies on hypothermic circulatory arrest, either alone or in conjunction with cerebral perfusion. Methods and Results-The perioperative and intraoperative conditions of 1558 patients submitted from 44 cardiac surgery centers in German-speaking countries were analyzed. Among patients with acute aortic dissection type A, 355 (22.8%) underwent surgery with hypothermic circulatory arrest alone. In 1115 patients (71.6%), cerebral perfusion was used: Unilateral antegrade cerebral perfusion (ACP) in 628 (40.3%), bilateral ACP in 453 (29.1%), and retrograde perfusion in 34 patients (2.2%). For 88 patients with acute aortic dissection type A (5.6%), no circulatory arrest and arch intervention were reported (cardiopulmonary bypass-only group). End points of the study were 30-day mortality (15.9% overall) and mortality-corrected permanent neurological dysfunction (10.5% overall). The respective values for the cardiopulmonary bypass-only group were 11.4% and 9.1%. Hypothermic circulatory arrest alone resulted in a 30-day mortality rate of 19.4% and a mortality-corrected permanent neurological dysfunction rate of 11.5%, whereas the rates were 13.9% and 10.0%, respectively, for unilateral ACP and 15.9% and 11.0%, respectively, for bilateral ACP. In contrast with the ACP groups, there was a profound increase in mortality when systemic circulatory arrest times exceeded 30 minutes in the hypothermic circulatory arrest group (PϽ0.001). Mortality-corrected permanent neurological dysfunction correlated significantly with perfusion pressure in the ACP groups. Conclusions-This

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Section: Cerebral Perfusionmentioning

confidence: 98%

Section: Differences In Cerebral Protection Strategiesmentioning

confidence: 99%

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

et al. 2011

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“…A theoretical advantage of axillary artery would be antegrade cerebral perfusion at the time of total circulatory arrest, after inominate artery balloon occlusion. Despite there is no consensus in the literature regarding this issue, we follow the growing world tendency on aortic arch surgery [16,[20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

Atik

Faber²,

Corso³

et al. 2009

Rev Bras Cir Cardiovasc

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Objectives: To determine indications and results of axillary artery cannulation for cardiopulmonary bypass.Methods: From January 2005 through December 2008, axillary artery cannulation was used in 48 patients. Mean age was 62 ±11 years and 33 patients (69%) were males. Axillary artery was approached by infraclavicular incision and the cannula introduced in a 8 millimeter Dacron side graft.Results: Indications were calcified aorta (N=18, 38%), aortic dissection (N=15, 31%), ascending and/or aortic arch aneurysm (N=11, 23%) and prior to reoperative median sternotomy (N=4, 8%). Changes in intraoperative planning occurred most often in patients with calcified aorta (100% versus 10%, P<.0001) than in patients with other indications, which follow their preoperative plan. Cardiopulmonary bypass (deep hypothermic circulatory arrest in 55% and conventional in the remaining) was uneventfully conducted in all patients but one (success rate 98%) due to undiagnosed inominate artery stenosis. Local complication was lymphatic drainage in three patients (6.2%). Bras Cir Cardiovasc 2009; 24(3): 404-408 Conclusions Rev

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“…Tab. 1; [3,5,7,10,13,14,19,21,24,28,32,38,42,46,47,56,62]). Bislang fehlt allerdings eine "Leitlinie" zum standardisierten perioperativen und chirurgischen Management dieser akut lebensbedrohlichen Aortenerkrankung.…”

Section: Erste Ergebnisseunclassified

Deutsches Register für akute Aortendissektion Typ A (GERAADA)

Conzelmann

Krüger

Hoffmann

et al. 2011

Herz

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A European Registry of Aortic Diseases ("EuRADa") is being established this year under the leadership of the "Vascular Domain" of the European Association for Cardio-Thoracic Surgery (EACTS). This database will collect parameters on all aortic diseases, dissection types A and B, aneurysms, perforating ulcer (PAU), intramural wall hematoma (IMH), traumatic aortic ruptures, and all potential treatment strategies (medical treatment, open surgical and endovascular).

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Advantages of subclavian artery perfusion for repair of acute type A dissection*1

Cited by 76 publications

References 14 publications

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

Artéria axilar na instalação de circulação extracorpórea: indicações e resultados

Deutsches Register für akute Aortendissektion Typ A (GERAADA)

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