Aortic arch surgery using bilateral antegrade selective cerebral perfusion in combination with near-infrared spectroscopy☆

Harrer, M.; Waldenberger, Ferdinand; Weiss, Gabriel; Folkmann, Sandra; Gorlitzer, Michael; Moidl, Reinhard; Grabenwoeger, Martin

doi:10.1016/j.ejcts.2010.03.016

Cited by 79 publications

(38 citation statements)

References 24 publications

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“…Bilateral antegrade cerebral perfusion has been shown to be safe in conjunction with moderate systemic hypothermia 4,5) . In the case reported here, AADA was complicated by dissection of all arch vessels with nearly complete true lumen collapse of the carotid arteries.…”

Section: Discussionmentioning

confidence: 99%

Modified Perfusion Strategy and Aortic Arch Debranching in Complicated Acute Aortic Dissection Type A: A Bridge to Definitive Endovascular Therapy

Rylski¹,

Siepe²,

Blanke³

et al. 2014

ATCS

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IntroductionPatients with acute aortic dissection type A (AADA) with aortic arch and supra-aortic vessel involvement have a higher risk of postoperative stroke. 1,2) Furthermore, the residual aortic arch and descending aorta dissection carries the risk of progressive aortic dilatation. 3) To prevent intra-or postoperative cerebral malperfusion and to facilitate subsequent therapy for potential aortic arch aneurysm an advanced cannulation technique should be used. As an alternative perfusion technique, we report bilateral antegrade cerebral perfusion through Dacron grafts attached to the true lumen of both common carotid arteries which are then subsequently used as an aorto-bi-carotid bypass. ReportA 65-year-old male was admitted for acute onset chest pain. Computed tomography (CT), performed 2 hours after onset of symptoms established the diagnosis of AADA with affection of the brachiocephalic trunk, left subclavian and both common carotid arteries. Aside from transient loss of consciousness, preoperative neurologic examination showed no deficit, although the right Introduction: Patients with acute aortic dissection type A (AADA) with aortic arch and supra-aortic vessel involvement have a higher postoperative stroke prevalence and risk of later aortic arch aneurysm development. Case Report: We report a case of AADA with involvement of supraaortic arteries, complicated by cerebral malperfusion. The ascending aorta was replaced using bilateral antegrade cerebral perfusion through side-grafts attached to both carotid arteries, which were subsequently used as aorto-bi-carotid bypass. One year later, the diameter of aortic arch increased to 5 cm. The endovascular treatment of aortic arch was easily performed since debranching was already almost complete. Conclusions: Immediate bilateral carotid artery inflow and subsequent aorto-bi-carotid bypass is a safe way to prevent cerebral malperfusion in the setting of complicated AADA. A potential benefit of this technique is almost complete debranching that facilitates an endovascular arch replacement.

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Section: Discussionmentioning

confidence: 99%

Modified Perfusion Strategy and Aortic Arch Debranching in Complicated Acute Aortic Dissection Type A: A Bridge to Definitive Endovascular Therapy

Rylski¹,

Siepe²,

Blanke³

et al. 2014

ATCS

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“…Так при 20°С уровень десатурации был 0,25% в минуту, это снижение не было линейным. При температуре 21-26°С прирост был 2% в минуту [14,[46][47][48]. rSO 2 является маркером адекватности дополнительной церебральной перфузии при операциях на дуге аорты.…”

Section: факторы риска развития но при кардиохирургических операцияхunclassified

“…rSO 2 является маркером адекватности дополнительной церебральной перфузии при операциях на дуге аорты. При по мощи ЦО выявили быструю десатурацию при циркуляторном аресте, медленную десатурацию при ретроградной перфузии ГМ и отсутствие десатурации при адекватной антеградной це ребральной перфузии [3,[46][47][48]. rSO 2 в некоторых клинических ситуациях может быть связан с уровнем глубины анестезии.…”

Section: факторы риска развития но при кардиохирургических операцияхunclassified

Cerebral Oximetry in Cardiac Surgery

Шепелюк¹,

Клыпа²,

Никифоров³

2012

rmt

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“…There are algorithms to increase perfusion flow in case of cerebral desaturation (37) and if it is not enough, bilateral infusion should be used if it was not previously established (90,91). This is why monitoring is used more and more often, although there are some doubts about whether it allows assessing deep brain oxygenation, in fact there seems to be a poor correlation with jugular venous saturation.…”

Section: Neurological Monitoringmentioning

confidence: 99%

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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Aortic arch surgery using bilateral antegrade selective cerebral perfusion in combination with near-infrared spectroscopy☆

Abstract: NIRS-guided BACP during MHCA allows a safe approach to complex aortic arch surgery. The drop of brain oxygenation values in the contralateral hemisphere during unilateral ACP strongly suggests the routine use of BACP, when circulatory arrest under tepid temperatures is used.

Cited by 79 publications

References 24 publications

Modified Perfusion Strategy and Aortic Arch Debranching in Complicated Acute Aortic Dissection Type A: A Bridge to Definitive Endovascular Therapy

Modified Perfusion Strategy and Aortic Arch Debranching in Complicated Acute Aortic Dissection Type A: A Bridge to Definitive Endovascular Therapy

Cerebral Oximetry in Cardiac Surgery

Intraoperative care for aortic surgery using circulatory arrest

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