Aortic arch aneurysm repair using selective cerebral perfusion

Tabayashi, Koichi; Ohmi, M; Togo, T; Miura, Makoto; Yokoyama, Hitoshi; Akimoto, Hiroji; Murata, S; Ohsaka, Kenji; Mohri, Hitoshi

doi:10.1016/0003-4975(94)91381-1

Cited by 33 publications

(9 citation statements)

References 20 publications

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“…Therefore the low incidence of temporary neurologic dysfunction observed in our series may be due to the use of selective antegrade celebral perfusion, which resulted in less ischemia-reperfusion injury. Other studies have demonstrated that selective cerebral perfusion provides adequate cerebral protection for a longer period than hypothermic circulatory arrest [6,7,16]. In fact, our patients tolerated well up to 4 h of selective cerebral perfusion.…”

Section: Discussionmentioning

confidence: 63%

“…In fact, our patients tolerated well up to 4 h of selective cerebral perfusion. High stroke rates reported in the early study that used cerebral perfusion technique was no more applicable to the modern techniques, in which lower perfusion rate and direct cannulation into the unaffected branches were employed [6,7,11,16]. The major drawback of selective cerebral perfusion is its complexity.…”

Section: Discussionmentioning

confidence: 99%

“…Hypothermic circulatory arrest [4,5,18], retrograde cerebral perfusion [8±10, 12,13] and selective cerebral perfusion [6,7,11,14,16] have been used for brain protection during aortic arch reconstruction. Reported results suggest that all these three techniques provide adequate protection of the brain from ischemia with their own advantages and disadvantages.…”

Section: Discussionmentioning

confidence: 99%

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Surgical management of atherosclerotic aortic arch aneurysms using selective cerebral perfusion: 7-year experience in 52 patients

Shiiya

Kunihara

Imamura

et al. 2000

European Journal of Cardio-Thoracic Surgery

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Objective: Patients with atherosclerotic aortic arch aneurysms are at greater risk for brain complication. We report our techniques and results of operation using selective cerebral perfusion. Methods: We retrospectively analyzed 52 consecutive patients with atherosclerotic aortic arch aneurysms (mean age, 70 years, range, 53±86 years), who underwent operation between April 1992 and March 1999. The operation was non-elective in 11 patients (21.1%). Concomitant operations included eight coronary artery bypass grafting and one aortic valve replacement. Simultaneous distal aortic reconstruction was performed in three patients. The operation was performed through median sternotomy. To avoid brain embolism, total arch replacement with a branched prosthesis was performed in 48 patients, in an attempt to exclude affected segments of aorta. In addition, retrograde femoral artery perfusion was avoided and cerebral circulation was isolated before aortic manipulation. To achieve even blood¯ow distribution, we employed perfusion and continuous pressure monitoring of all the three arch vessels. The perfusion rate was 12^2 ml/kg per min and the pressure was kept around 50 mmHg. Deep hypothermic arrest of the lower torso (bladder temperature, 228C) was used during open distal aortic anastomosis. Results: The hospital mortality rate was 11.5% (six of 52), and 7.3% (three of 41) for elective cases. Only one patient (1.9%) developed permanent focal neurological de®cit. Six other patients showed temporary brain complications, which was global (delirium) in three and focal in three others. Conclusions: Selective cerebral perfusion is a safe brain protection method, and our strategy seems effective for embolic stroke prevention. q

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Surgical management of atherosclerotic aortic arch aneurysms using selective cerebral perfusion: 7-year experience in 52 patients

Shiiya

Kunihara

Imamura

et al. 2000

European Journal of Cardio-Thoracic Surgery

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“…7 Total aortic arch replacement was accomplished using a graft with three side branches for reattachment of the branches. Before 1992, we used a double-barrel technique for distal anastomosis of the aortic arch replacement, but after 1992 the distal end of the graft was anastomosed solely to the true lumen.…”

Section: Operative Proceduresmentioning

confidence: 99%

Results of Aortic Surgery in Patients with Marfan Syndrome

et al. 2005

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“…the most important reason for chosing the retrograde cerebral perfusion is itssimplicity (11). One main critici sm of thi s met hod is the pressu redependent time limit and the inhomogeneous distribution of flow wi th a consequent risk of localized brain injury (13). This method can also cause a blood distribution into the inferior venacava throughtheazygosvein and other collaterals, or even restrict the flow of the retrogra de cerebral perfusion through the venous valves, which has a reported occurrence of upto 88%…”

Section: Postoperative Neurological Investigation Was Performed By a mentioning

confidence: 99%

An Assessment of Selective Cerebral Perfusion Via the Innominate Artery in Aortic Arch Replacement

Wozniak

Dapper

Schindler

et al. 1998

Thorac cardiovasc Surg

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Maintaining an adequate cerebral oxygen supply is a serious problem in aortic arch surgery. Deep hypothermic circulatory arrest is the most common method used for cerebral protection, but guarantees only a time-limited safety period. Based on experimental investigations, we applied selective cerebral perfusion via the innominate artery alone with only moderate hypothermia (28 degrees C) and without circulatory arrest in 25 consecutive patients undergoing surgical treatment of an aneurysm (n = 10) or acute type-A dissection (n = 15) involving the aortic valve and arch. In every case a test perfusion was carried out to assess whether the cerebral perfusion achieved would be adequate for the whole operation. In no case was the perfusion inadequate. As a new perioperative monitoring system, we used computer-aided topographical electroencephalometry (CATEEM). There were 18 male and 7 female patients, their age was 47.0 +/- 15.1 years (mean +/- SD). Mean time periods were 155.1 +/- 37.3 min for aortic cross-clamping, and 69.3 +/- 35 min for selective cerebral perfusion. Postoperatively, two patients (8%) revealed a temporary left-sided hemiparesis, and 4 patients (16%) died within 30 days. The overall mortality rate was 16% in a follow-up period of 24.2 +/- 9.5 months. In this small group the CATEEM monitoring enabled an intraoperative selection of patients with sufficient bihemispheric collateral circulation and therefore suitable for simple innominate artery perfusion.

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Aortic arch aneurysm repair using selective cerebral perfusion

Cited by 33 publications

References 20 publications

Surgical management of atherosclerotic aortic arch aneurysms using selective cerebral perfusion: 7-year experience in 52 patients

Surgical management of atherosclerotic aortic arch aneurysms using selective cerebral perfusion: 7-year experience in 52 patients

Results of Aortic Surgery in Patients with Marfan Syndrome

An Assessment of Selective Cerebral Perfusion Via the Innominate Artery in Aortic Arch Replacement

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