Does retrograde cerebral perfusion via superior vena cava cannulation protect the brain?

Künzli, Andreas; Zingg, Patrick O.; Zünd, Gregor; Leskosek, B.; Segesser, Ludwig K. von

doi:10.1016/j.ejcts.2006.08.024

Cited by 19 publications

(7 citation statements)

References 9 publications

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“…This re ects the fact that the RIVP + ACP group had a slightly lower RIFLE classi cation, although aortic dissection in that group more often involved the celiac trunk artery and right renal artery than in the ACP group. The protective effects may be explained by RIVP blood for providing continuous oxygenation to the lower body, as well as cooling and ushing out the particular embolic debris, similarly to retrograde superior vena caval perfusion 25 .…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, patients in the ACP group were maintained at a nasopharyngeal temperature of 24-26 °C and a rectal temperature of 26-28 °C in accordance with previous reports. 26,27 The higher temperature in the RIVP + ACP group shortened CPB time, which may be bene t to shorten the ventilation time via attenuating the in ammatory response in the lung induced by the arti cial material of the CPB circuit 28 .…”

Section: Resultsmentioning

confidence: 99%

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Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Lin

Liu

Xiong

et al. 2020

Preprint

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Abstract OBJECTIVESAntegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes.METHODSThis pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products.RESULTSA total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21–1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, p = 0.006; OR: 0.26; 95% CI: 0.10–0.67). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group.CONCLUSIONSRIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications.Trial registrationPilot study of a RCT registered in clinicaltrials.gov (NCT03607786)，Registered 30 July, 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Lin

Liu

Xiong

et al. 2020

Preprint

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“…Cheung and associates measured O 2 extraction, pH, and PCO 2 from the RCP inflow and outflow in humans which demonstrated near maximal brain oxygen extraction suggesting relative cerebral hypoperfusion during RCP (14). A cadaveric study using in vitro venous retroperfusion showed that in humans most of the valves of the internal jugular vein are competent and potentially obstruct RCP (15). Transcranial Doppler studies aimed at evaluating the flow velocity in the middle cerebral artery during RCP gave mixed results (16).…”

Section: Discussionmentioning

confidence: 99%

Retrograde perfusion through superior vena cava reaches the brain during circulatory arrest

et al. 2018

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“…Competent valves in the internal jugular venous system can impede retrograde flow, although blood flow may still reach the brain through collateral veins [83]. McQuillen et al performed MRI studies on newborns with CHD.…”

Section: Decreasing Neurologic Morbidity During Cpbmentioning

confidence: 99%

Neurocognitive Monitoring and Care During Pediatric Cardiopulmonary Bypass — Current and Future Directions

Lee¹,

Easley²,

Brady³

2008

CCR

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Neurologic injury in patients with congenital heart disease remains an important source of morbidity and mortality. Advances in surgical repair and perioperative management have resulted in longer life expectancies for these patients. Current practice and research must focus on identifying treatable risk factors for neurocognitive dysfunction, advancing methods for perioperative neuromonitoring, and refining treatment and care of the congenital heart patient with potential neurologic injury. Techniques for neuromonitoring and future directions will be discussed.

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Does retrograde cerebral perfusion via superior vena cava cannulation protect the brain?

Cited by 19 publications

References 9 publications

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Retrograde perfusion through superior vena cava reaches the brain during circulatory arrest

Neurocognitive Monitoring and Care During Pediatric Cardiopulmonary Bypass — Current and Future Directions

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