Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

Chan, Sze-Chun; Underwood, Malcolm J.; Ho, Anthony M.‐H.; So, Jack M.; Ho, Adrienne K.; Wan, Innes Y.P.; Wong, Randolph H.L.

doi:10.1007/s12630-014-0181-2

Cited by 15 publications

(6 citation statements)

References 22 publications

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“…Some possible explanations for the regional desaturation are right hemispheric and vertebra-basilar hypoperfusion due to SACP cannula malpositioning in the brachiocephalic trunk (e.g., toward the right subclavian artery), or runoff of rightsided SACP flow or partial outflow obstruction of the right SACP cannula. 29,30 An alternative explanation might be particulate or air embolism to the right MCA, affecting oxygen supply to only parts of its vascular territory. 31,32 At any rate, oxygen delivery by the SACP to the right ACA appeared slightly less than to the left ACA area but sufficient to prevent progressive right-frontal tissue oxygen desaturation.…”

Section: Discussionmentioning

confidence: 99%

“…A recent publication of a case with SACPwhich was complicated by a right-sided frontal NIRS reduction-demonstrated that repositioning of the cannula can restore oxygenation within seconds. 29 Another trial in patients undergoing coronary artery bypass graft surgery, which assessed the frequency of frontal cerebral oxygen desaturation during CPB and the efficacy of an intervention algorithm to redress it recorded failure to restore oxygenation in only 5% of desaturation events. However, possible reasons for failure to restore oxygenation in these cases and its consequences were not further discussed.…”

Section: Discussionmentioning

confidence: 99%

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Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

et al. 2018

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Stroke due to hypoperfusion or emboli is a devastating adverse event of cardiac surgery, but early detection and treatment could protect patients from an unfavorable postoperative course. Hypoperfusion and emboli can be detected with transcranial Doppler of the middle cerebral artery (MCA). The measured blood flow velocity correlates with cerebral oxygenation determined clinically by near-infrared spectroscopy (NIRS) of the frontal cortex. We tested the potential advantage of a spatially extended NIRS in detecting critical events in three cardiac surgery patients with a whole-head fiber holder of the FOIRE-3000 continuous-wave NIRS system. Principle components analysis was performed to differentiate between global and localized hypoperfusion or ischemic territories of the middle and anterior cerebral arteries. In one patient, we detected a critical hypoperfusion of the right MCA, which was not apparent in the frontal channels but was accompanied by intra- and postoperative neurological correlates of ischemia. We conclude that spatially extended NIRS of temporal and parietal vascular territories could improve the detection of critically low cerebral perfusion. Even in severe hemispheric stroke, NIRS of the frontal lobe may remain normal because the anterior cerebral artery can be supplied by the contralateral side directly or via the anterior communicating artery.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

et al. 2018

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“…7 One such strategy includes concomitant direct cannulation of the left carotid artery from within the aortic arch with a balloon-tipped cannula. 4 In addition, direct clamping of the left carotid artery near its origin from the aortic arch has also been advocated. 8 This technique has the added benefit of reducing the volume of blood flooding the surgical field caused by retrograde flow from collateral vessels in the Circle of Willis via the right-sided circulation that exits at the carotid orifice into the arch.…”

Section: Discussionmentioning

confidence: 99%

External carotid compression: a novel technique to improve cerebral perfusion during selective antegrade cerebral perfusion for aortic arch surgery

Grocott

Ambrose

Moon

2016

Can J Anesth/J Can Anesth

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External carotid compression: a novel technique to improve cerebral perfusion during selective antegrade cerebral perfusion for aortic arch surgery La compression externe de la carotide: une technique innovante pour améliorer la perfusion cérébrale pendant une perfusion cérébrale antérograde sélective pour une chirurgie de la crosse aortique Abstract Purpose Selective antegrade cerebral perfusion (SACP) involving cannulation of either the axillary or innominate artery is a commonly used technique for maintaining cerebral blood flow (CBF) during the use ofhypothermic cardiac arrest (HCA) for operations on the aortic arch. Nevertheless, asymmetrical CBF with hypoperfusion of the left cerebral hemisphere is a common occurrence during SACP. The purpose of this report is to describe an adjunctive maneuver to improve left hemispheric CBF during SACP by applying extrinsic compression to the left carotid artery. Clinical features A 77-yr-old male patient with a history of aortic valve replacement presented for emergent surgical repair of an acute type A aortic dissection of a previously known ascending aortic aneurysm. His intraoperative course included cannulation of the right axillary artery, which was used as the aortic inflow during cardiopulmonary bypass and also allowed for subsequent SACP during HCA. After the onset of HCA, the innominate artery was clamped at its origin to allow for SACP. Shortly thereafter, however, the left-sided cerebral oxygen saturation (SrO 2 ) began to decrease. Augmenting the PaO 2 , PaCO 2 and both SACP pressure and flow failed to increase left hemispheric SrO 2 . Following the use of ultrasound guidance to confirm the absence of atherosclerotic disease in the carotid artery, external pressure was applied partially compressing the artery. With the carotid compression, the left cerebral saturation abruptly increased, suggesting pressurization of the left cerebral hemispheric circulation and augmentation of CBF. Conclusions Direct ultrasound visualization and cautious partial compression of the left carotid artery may address asymmetrical CBF that occurs with SACP during HCA for aortic arch surgery. This strategy may lead to improved symmetry of CBF and corresponding cerebral oximetry measurements during aortic arch surgery. RésuméObjectif La perfusion cérébrale antérograde sélective réalisée via la canulation de l'artère axillaire ou du tronc artériel brachiocéphalique est une technique répandue pour maintenir la circulation sanguine cérébrale pendant un arrêt circulatoire hypothermique pour les opérations de la crosse aortique. Toutefois, on observe fréquemment une circulation sanguine cérébrale asymétrique accompagnée d'une hypoperfusion de l'hémisphère cérébrale gauche pendant la perfusion cérébrale antérograde sélective. L'objectif de ce compte rendu est de décrire une manoeuvre d'appoint destinée à améliorer la circulation sanguine cérébrale pendant la Electronic supplementary material The online version of this article

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“…A drop in regional cerebral O 2 saturation of more than 20% would signify inadequate cerebral perfusion and we alter our cannulation site to the axillary artery or other sites to correct the malperfusion. 1 We routinely cannulate the right atrial appendage with a two-stage venous cannula, and vent the left ventricle via the right superior pulmonary vein. Systemic cooling to 25℃ is commenced.…”

Section: Techniquementioning

confidence: 99%

Multimodality imaging assessment for Thoraflex hybrid total arch replacement

Wong

Underwood

2016

Asian Cardiovasc Thorac Ann

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Conventionally, aortic pathologies involving the ascending, arch, and descending thoracic aorta are treated by a staged operation. The Thoraflex device is a composite 4-branched graft with a distal endovascular stent, which allows one-stage treatment of these pathologies. We describe our multimodality hybrid approach for total arch replacement using the Thoraflex device with the adjunct of intraoperative 3-dimensional transesophageal echocardiography, Endo-EYE endoscopy, and on-table aortography in a hybrid operating room. These multimodality assessments can ascertain adequate sealing of a distal aortic tear and proper opening of the endograft, and provide on-table functional assessment of false lumen hemodynamics. Early results are promising.

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Cannula malposition during antegrade cerebral perfusion for aortic surgery: role of cerebral oximetry

Cited by 15 publications

References 22 publications

Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

Spatially extended versus frontal cerebral near-infrared spectroscopy during cardiac surgery: a case series identifying potential advantages

External carotid compression: a novel technique to improve cerebral perfusion during selective antegrade cerebral perfusion for aortic arch surgery

Multimodality imaging assessment for Thoraflex hybrid total arch replacement

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