Comparative clinical study between retrograde cerebral perfusion and selective cerebral perfusion in surgery for acute type A aortic dissection

Usui, Akihiko; Yasuura, K; Watanabe, Takashi; Maseki, T

doi:10.1016/s1010-7940(99)00096-2

Cited by 37 publications

(35 citation statements)

References 11 publications

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“…In general, the RCP procedure should not exceed 60 min, and a longer RCP duration has been reported to be associated with the incidence of stroke. 21 In the present study, however, the anastomosis time normally did not exceed the safe duration of RCP, given that cases involving branch vessel reconstruction were excluded. As another drawback, there is a theoretical controversy regarding the blood supply effects of RCP.…”

Section: Discussionmentioning

confidence: 72%

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Tokuda¹,

Matsubara

Motomura

et al. 2014

Circ J

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Section: Discussionmentioning

confidence: 72%

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Tokuda¹,

Matsubara

Motomura

et al. 2014

Circ J

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“…In the last decade, RCP has become less popular in spite of good reported results. 13,14 Because of our very low patient numbers, we cannot compare RCP to other forms of cerebral protection. ACP preserves the natural flow direction, allows for higher pressure, and probably provides metabolically adequate perfusion.…”

Section: Cerebral Perfusionmentioning

confidence: 99%

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

et al. 2011

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on behalf of the GERAADA Investigators Background-Cerebral protection during surgery for acute aortic dissection type A relies on hypothermic circulatory arrest, either alone or in conjunction with cerebral perfusion. Methods and Results-The perioperative and intraoperative conditions of 1558 patients submitted from 44 cardiac surgery centers in German-speaking countries were analyzed. Among patients with acute aortic dissection type A, 355 (22.8%) underwent surgery with hypothermic circulatory arrest alone. In 1115 patients (71.6%), cerebral perfusion was used: Unilateral antegrade cerebral perfusion (ACP) in 628 (40.3%), bilateral ACP in 453 (29.1%), and retrograde perfusion in 34 patients (2.2%). For 88 patients with acute aortic dissection type A (5.6%), no circulatory arrest and arch intervention were reported (cardiopulmonary bypass-only group). End points of the study were 30-day mortality (15.9% overall) and mortality-corrected permanent neurological dysfunction (10.5% overall). The respective values for the cardiopulmonary bypass-only group were 11.4% and 9.1%. Hypothermic circulatory arrest alone resulted in a 30-day mortality rate of 19.4% and a mortality-corrected permanent neurological dysfunction rate of 11.5%, whereas the rates were 13.9% and 10.0%, respectively, for unilateral ACP and 15.9% and 11.0%, respectively, for bilateral ACP. In contrast with the ACP groups, there was a profound increase in mortality when systemic circulatory arrest times exceeded 30 minutes in the hypothermic circulatory arrest group (PϽ0.001). Mortality-corrected permanent neurological dysfunction correlated significantly with perfusion pressure in the ACP groups. Conclusions-This

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“…RCP has been found to be associated with neurological morbidity rates that are either similar to those associated with HCA [15,16] or lower [17,18], especially in older patients [19]. In studies which included selective (anterograde) cerebral perfusion patients, RCP patients had similar outcome in two studies [20,21], and worse outcome in one [22].…”

Section: Clinical Outcome In Thoracic Aortic Surgerymentioning

confidence: 99%

Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction

Reich

Uysal

Ergin

et al. 2001

European Journal of Cardio-Thoracic Surgery

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Objective: Retrograde cerebral perfusion (RCP) is commonly used in thoracic aortic surgery, ostensibly to provide metabolic support, maintain cerebral hypothermia and/or wash out particulate emboli. We tested the hypothesis that RCP would affect neuropsychological outcome in a clinical cohort. Methods: Ninety-four patients undergoing elective thoracic aortic repairs requiring deep hypothermic circulatory arrest consented to participate in this study. These patients underwent preoperative neuropsychological evaluation and comprise the reference group. Fifty-six of these patients also underwent neuropsychological evaluation several weeks postoperatively, 12 of whom (21%) had RCP. The neuropsychological domains tested were attention, processing speed, memory, executive function, and ®ne motor function. A global assessment of impairment, negative neuropsychological outcome (NNO), was de®ned as a postoperative decrease in function in two or more neuropsychological domains for patients with at least three domains tested both pre-and postoperatively (n 48). The relationship of three potential predictors (RCP, cerebral ischemia time and patient age) to negative outcomes was analyzed using Wilcoxon two-sample tests, x 2 tests, Mantel±Haenszel tests and multiple logistic regression. P , 0:05 was considered signi®cant. Results: Memory dysfunction and NNO had strong associations with RCP. This effect remained signi®cant when controlling separately for age and cerebral ischemia time. Conclusions: The effects of RCP are dif®cult to distinguish from those of age and prolonged cerebral ischemia time, because complex thoracic aortic repairs are associated with advanced age, prolonged cerebral ischemia and use of RCP. Despite this limitation, these preliminary data indicated that RCP had no bene®cial effect (and most likely a negative effect) upon cognitive outcome. q

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Comparative clinical study between retrograde cerebral perfusion and selective cerebral perfusion in surgery for acute type A aortic dissection

Abstract: RCP can be performed without clamping or cannulation of the cervical arteries, which is an advantage in reducing the chances of arterial injury or cerebral embolization. RCP is comparable to SCP in terms of clinical outcome.

Cited by 37 publications

References 11 publications

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

Cerebral Protection During Surgery for Acute Aortic Dissection Type A

Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction

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