Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection

Kodama, Hiroshi; Takahashi, Shinya; Okazaki, Takao; Morita, Shohei; Go, Seimei; Watanabe, Masahiro; Yamane, Yasuo; Katayama, Kosuke; Kurosaki, T.; Sueda, Taijiro

doi:10.23736/s0021-9509.18.10639-2

Cited by 2 publications

(2 citation statements)

References 21 publications

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“…Dissection-related malperfusion can result in cerebral infarction, limb ischemia, an so on. 3,4 Therefore, once diagnosed, all patients should be treated as soon as possible.…”

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confidence: 99%

Use of del Nido cardioplegia in acute aortic dissection surgery

et al. 2020

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Objective: Del Nido cardioplegia solution provides a depolarized hyperkalemic arrest lasting up to 60 minutes. Single-dose del Nido cardioplegia solution may offer an alternative myocardial protection strategy to conventional whole blood cardioplegia following acute aortic dissection surgery. Methods: We retrospectively reviewed 122 consecutive patients with acute aortic dissection undergoing arch reconstruction surgery procedure with cardioplegia arrest from January 2017 to December 2019. Patients exclusively received with whole blood cardioplegia (n = 60, January 2017–December 2018) or del Nido cardioplegia (n = 62, January 2018–December 2019). Preoperative and postoperative data were retrospectively reviewed. Results: No significant difference between two groups in mortality (4/60 vs 3/62, p = 0.964), cardiopulmonary bypass time (168.0 ± 10.5 minute vs 165.0 ± 12.5 minute, p = 0.154), aortic cross-clamp time (91.8 ± 9.0 minute vs 93.2 ± 9.5 minute, p = 0.405), selective antegrade cerebral perfusion time (21.8 ± 5.0 minute vs 22.4 ± 4.7 minute, p = 0.496) and postoperative vasoactive inotropic score (34.8 ± 1.9 vs 35.2 ± 2.1, p = 0.272), neurological complications rate (8/60 vs 12/62, p = 0.523), renal insufficiency rate (5/60 vs 7/62, p = 0.807) and the troponin T level (304.8 ± 111.3 vs 315.0 ± 94.9, p = 0.588), respectively. Mean volume of crystalloid was significantly higher in the del Nido group compared to the whole blood cardioplegia group (1010.2 ± 20.3 mL vs 300.0 ± 19.6 mL, p < 0.001). Patients requiring defibrillation was 7/62 vs 28/60 (p < 0.001), with statistical difference in both groups. Conclusion: Short-term outcomes in acute aortic dissection surgery using del Nido cardioplegia solution were acceptable and comparable to conventional multi-dose whole blood cardioplegia. Del Nido cardioplegia technique is associated with lower defibrillations rate and requires a reduced frequency of infusions that results in longer durations between infusions and may be a feasible alternative to conventional whole blood cardioplegia solution in acute aortic dissection surgery.

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“…Dissection-related malperfusion can result in cerebral infarction, limb ischemia, an so on. 3,4 Therefore, once diagnosed, all patients should be treated as soon as possible.…”

mentioning

confidence: 99%

Use of del Nido cardioplegia in acute aortic dissection surgery

et al. 2020

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“…Given these findings, we can hypothesize two scenarios: (i) the AKA originated at a lower or upper level through some collateral vessels that were not meant to be concerned by the intervention; (ii) the diameter of the AKA was too small to allow a contrast opacification, in which case, it was probably too small to be the main feeder vessel to the ASA as well. Moreover, the relatively high rate of patients treated for type B dissection can explain the low rate of AKA visualization, as the intimal flap can be responsible for hemodynamic modifications causing redistribution of the ASA's flow through a collateral network [21].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Spinal Arterial Supply Mapping Using Non-Selective Cone Beam Computed Tomography before Complex Aortic Repair

Bonnet,

Kobeiter,

Pescatori

et al. 2024

JCM

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Pre-op spinal arterial mapping is crucial for complex aortic repair. This study explores the utility of non-selective cone beam computed tomography (CBCT) for pre-operative spinal arterial mapping to identify the Adamkiewicz artery (AKA) in patients undergoing open or endovascular repair of the descending thoracic or thoracoabdominal aorta at risk of spinal cord ischemia. Pre-operative non-selective dual-phase CBCT after intra-aortic contrast injection was performed in the aortic segment to be treated. The origin of detected AKA was assessed based on image fusion between CBCT and pre-interventional computed tomography angiography. Then, the CBCT findings were compared with the incidence of postoperative spinal cord ischemia (SCI). Among 21 included patients (median age: 68 years, 20 men), AKA was detected in 67% within the explored field of view, predominantly from T7 to L1 intercostal and lumbar arteries. SCI occurred in 14%, but none when AKA was not detected (p < 0.01). Non-selective CBCT for AKA mapping is deemed safe and feasible, with potential predictive value for post-surgical spinal cord ischemia risk. The study concludes that non-selective aortic CBCT is a safe and feasible method for spinal arterial mapping, providing promising insights into predicting post-surgical SCI risk.

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Association between false lumen segmental arteries and spinal cord ischemia in type A acute aortic dissection

Cited by 2 publications

References 21 publications

Use of del Nido cardioplegia in acute aortic dissection surgery

Use of del Nido cardioplegia in acute aortic dissection surgery

Preoperative Spinal Arterial Supply Mapping Using Non-Selective Cone Beam Computed Tomography before Complex Aortic Repair

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