Brain protection in aortic arch aneurysm: antegrade or retrograde?

Harky, Amer; Fok, Matthew; Bashir, Mohamad; Estrera, Anthony L.

doi:10.1007/s11748-017-0879-5

Cited by 11 publications

(10 citation statements)

References 59 publications

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“…IA cannulation also avoids the risks of a retrograde perfusion, such as cerebral emboli and malperfusion following femoral cannulation . A disadvantage of IA cannulation is that its use is limited to IA that is not diseased . The literature did not report the incidence of discovering a diseased IA in the preoperative work up or during the surgery which would make it unacceptable for cannulation.…”

Section: Resultsmentioning

confidence: 98%

Innominate artery cannulation in aortic surgery: A systematic review

et al. 2018

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Objective: The innominate artery is considered an alternative site for establishing cardiopulmonary bypass in surgical procedures involving the thoracic aorta. This systematic review examines the use of innominate artery cannulation in aortic surgery.Methods: A systematic literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all studies that utilized innominate artery cannulation for establishing cardiopulmonary bypass and providing cerebral perfusion in thoracic aortic surgery. The data were reviewed up to September 2018.Results: Acute type A aortic dissection contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719) underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending and hemi-arch replacement, while 11.5% had total aortic arch replacement and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111). All-cause 30-day mortality rate was 2.7% (n = 61).Conclusion: Innominate artery cannulation is a safe technique in patients who undergo thoracic aortic surgery. It can be utilized, in selected cases, as a reliable route for establishing cardiopulmonary bypass and maintaining cerebral perfusion. K E Y W O R D S aorta, aortic surgery, cannulation, innominate artery

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Section: Resultsmentioning

confidence: 98%

Innominate artery cannulation in aortic surgery: A systematic review

et al. 2018

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“…These data indicate the lack of clear evidence supporting the superiority of either SACP or DHCA with RCP in terms of neuroprotection. 49 Nevertheless, RCP combined with DHCA might offer a safe time limit for antegrade cerebral circulatory arrest. While many studies [27][28][29]35,36 indicate a circulatory arrest time of approximately 30 min for this adjunctive technique, determining the differences between the two methods within such a timeframe might be difficult.…”

Section: Selective Antegrade Cerebral Perfusion Versus Retrograde Cer...mentioning

confidence: 99%

Neuroprotection during Open Aortic Arch Surgery: Cerebral Perfusion Methods and Temperature

Bessho

2023

J Nippon Med Sch

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Neuroprotection is important in open aortic arch surgery because of the dependence of brain tissues on cerebral perfusion. Therefore, several techniques have been developed to reduce cerebral ischemia and improve outcomes in open aortic arch surgery. In this review, I describe various neuroprotective strategies, such as profound and deep hypothermic circulatory arrest, selective antegrade cerebral perfusion, retrograde cerebral perfusion, and lower body circulatory arrest; compare their advantages and disadvantages, and discuss their evolution and current status by reviewing relevant literature.

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“…4 Beyond 50 min, cellular anoxia and injury occur with significantly increased rates of neurologic dysfunction. 5,6 In experienced centers, however, some groups have reported excellent outcomes with straight DHCA for periods of up to 40 min. In their series of all-comers undergoing straight DHCA, the Yale group reported excellent long-term results with a mean duration of DHCA of 29.7 AE 8.5 min, with 85.5% of patients undergoing < 40 min and 3.1% > 50 min.…”

Section: Deep Hypothermic Circulatory Arrestmentioning

confidence: 99%

Goal-directed cerebral perfusion in aortic arch surgery: scientific leap or hype?

Lou

Chen

2020

Asian Cardiovasc Thorac Ann

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Although significant advancements in cerebral protection strategies in aortic surgery have been achieved in recent years, controversy remains on what constitutes the optimal strategy. Deep hypothermic circulatory arrest alone is a viable approach in many instances, but the need for a prolonged duration of circulatory arrest and increasing case complexity have led to the utilization of adjunctive cerebral perfusion strategies. In this review, we discuss the efficacy of deep hypothermic circulatory arrest and its limitations, the role of retrograde cerebral perfusion and unilateral and bilateral antegrade cerebral perfusion, and the trend towards goal-directed perfusion strategies, all emphasizing the pressing need for randomized clinical trials to better define the optimal strategy.

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Brain protection in aortic arch aneurysm: antegrade or retrograde?

Cited by 11 publications

References 59 publications

Innominate artery cannulation in aortic surgery: A systematic review

Innominate artery cannulation in aortic surgery: A systematic review

Neuroprotection during Open Aortic Arch Surgery: Cerebral Perfusion Methods and Temperature

Goal-directed cerebral perfusion in aortic arch surgery: scientific leap or hype?

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