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

Lou, Xiaoying; Chen, Edward P.

doi:10.1177/0218492320929212

Cited by 3 publications

(1 citation statement)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lou and his colleague have dwelled upon the controversies of deep hypothermic circulatory arrest alone as a viable option and the pros and cons of retrograde and antegrade cerebral perfusion. 4 They have stressed the need for randomized clinical trials to better define the optimal strategy.…”

Section: Controversyigniting Further Researchmentioning

confidence: 99%

Controversy handled well, ends in veracity

Idhrees¹,

Bashir²

2021

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Section: Controversyigniting Further Researchmentioning

confidence: 99%

Controversy handled well, ends in veracity

Idhrees¹,

Bashir²

2021

Asian Cardiovasc Thorac Ann

View full text Add to dashboard Cite

Application Value of Central Venous-arterial Carbon Dioxide Partial Pressure Difference in Postoperative Cognitive Dysfunction in Patients with Acute Aortic Dissection

Wang,

Zhu

et al. 2024

Preprint

View full text Add to dashboard Cite

Objective This study aims to investigate the clinical application value of the central venous-arterial carbon dioxide partial pressure difference (Pv-aCO2) in postoperative cognitive dysfunction(POCD) in patients with acute aortic dissection. Methods A retrospective analysis was conducted on the general data of 236 patients. Blood gas samples were collected from the arterial and venous lines at various time points during the surgery, including before and after the initiation of cardiopulmonary bypass (CPB), immediately after CPB initiation, before and after deep hypothermic circulatory arrest, 30 minutes after rewarming, and 5 minutes before weaning from CPB. The partial PV-aCO2 was calculated. Based on the average PV-aCO2 value, patients were divided into an observation group (PV-aCO2 > 6 mmHg, n = 112) and a control group (PV-aCO2 < 6 mmHg, n = 124). The perioperative data and Mini-Mental State Examination (MMSE) scores were compared between the two groups to assess the incidence and severity of POCD. Additionally, the expression levels of peripheral serum S100β in the two groups were compared 6 hours postoperatively. Results The incidence of POCD was higher in the observation group compared to the control group, while MMSE scores and serum S100β levels were lower in the observation group. Additionally, the observation group patients with POCD had lower MMSE scores and serum S100β levels compared to the control group patients. In addition, logistic regression analysis revealed that advanced age, serum S100β levels, female gender, CPB time, unilateral brain perfusion time, hyperlipidemia, diabetes, and smoking history were all independent risk factors for postoperative POCD (all P < 0.05). Conclusion Pv-aCO2 can effectively reflect the intraoperative cerebral metabolic level in patients with acute aortic dissection and can serve as an intraoperative warning indicator for cognitive dysfunction. Its clinical recommendation for use is warranted.

show abstract

Optimization of Hypothermic Protocols for Neurocognitive Preservation in Aortic Arch Surgery: A Literature Review

Llerena-Velastegui,

Velastegui-Zurita,

Zumbana-Podaneva

et al. 2024

JCDD

View full text Add to dashboard Cite

Shifts from deep to moderate hypothermic circulatory arrest (HCA) in aortic arch surgery necessitate an examination of their differential impacts on neurocognitive functions, especially structured verbal memory, given its significance for patient recovery and quality of life. This study evaluates and synthesizes evidence on the effects of deep (≤20.0 °C), low-moderate (20.1–24.0 °C), and high-moderate (24.1–28.0 °C) hypothermic temperatures on structured verbal memory preservation and overall cognitive health in patients undergoing aortic arch surgery. We evaluated the latest literature from major medical databases such as PubMed and Scopus, focusing on research from 2020 to 2024, to gather comprehensive insights into the current landscape of temperature management during HCA. This comparative analysis highlights the viability of moderate hypothermia (20.1–28.0 °C), supported by recent trials and observational studies, as a method to achieve comparable neuroprotection with fewer complications than traditional deep hypothermia. Notably, low-moderate and high-moderate temperatures have been shown to support substantial survival rates, with impacts on structured verbal memory preservation that necessitate careful selection based on individual surgical risks and patient profiles. The findings advocate for a nuanced approach to selecting hypothermic protocols in aortic arch surgeries, emphasizing the importance of tailoring temperature management to optimize neurocognitive outcomes and patient recovery. This study fills a critical gap in the literature by providing evidence-based recommendations for temperature ranges during HCA, calling for ongoing updates to clinical guidelines and further research to refine these recommendations. The implications of temperature on survival rates, complications, and success rates underpin the necessity for evolving cardiopulmonary bypass techniques and cerebral perfusion strategies to enhance patient outcomes in complex cardiovascular procedures.

show abstract

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

Cited by 3 publications

References 34 publications

Controversy handled well, ends in veracity

Controversy handled well, ends in veracity

Application Value of Central Venous-arterial Carbon Dioxide Partial Pressure Difference in Postoperative Cognitive Dysfunction in Patients with Acute Aortic Dissection

Optimization of Hypothermic Protocols for Neurocognitive Preservation in Aortic Arch Surgery: A Literature Review

Contact Info

Product

Resources

About