Hemiarch Replacement at 28°C: An Analysis of Mild and Moderate Hypothermia in 500 Patients

Leshnower, Bradley G.; Myung, Richard J.; Thourani, Vinod H.; Halkos, Michael E.; Kilgo, Patrick D.; Puskas, John D.; Chen, Edward P.

doi:10.1016/j.athoracsur.2012.02.069

Cited by 68 publications

(72 citation statements)

References 13 publications

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“…The results of the current study, along with our previously reported data, support the concept that MHCA plus uSACP provides excellent cerebral protection during the period of circulatory arrest required for emergent and elective, hemiarch and total arch reconstruction [4,[10][11][12]. Therefore, the main question that remains is whether visceral organ protection is compromised with the use of MHCA as opposed to DHCA.…”

Section: Commentsupporting

confidence: 88%

“…In a previous report comparing elective hemiarch reconstruction under two different levels of hypothermia, we also observed a reduction in postoperative mechanical ventilation requirements for patients undergoing HCA at warmer temperatures [11]. There are two possible explanations for these findings.…”

Section: Commentmentioning

confidence: 53%

“…Since 2004, right axillary artery cannulation and unilateral selective antegrade cerebral perfusion (uSACP) have been combined with HCA as the preferred method of circulation management at Emory for all emergent and elective cases requiring aortic arch reconstruction [4,[10][11][12]. Over the course of this decade, we have evolved from the use of DHCA to the use of MHCA for repair of ATAAD while maintaining the use of right axillary artery cannulation and uSACP.…”

mentioning

confidence: 98%

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Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection

Leshnower

Thourani

Halkos

et al. 2015

The Annals of Thoracic Surgery

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Section: Commentsupporting

confidence: 88%

Section: Commentmentioning

confidence: 53%

mentioning

confidence: 98%

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Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection

Leshnower

Thourani

Halkos

et al. 2015

The Annals of Thoracic Surgery

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“…Some studies associate renal dysfunction with creatinine levels, 29,34,35 whereas others define it according to urine output 34 or use of dialysis. 36 Many other studies only perfunctorily mention renal dysfunction or failure without providing a clear definition. 21,32,37,38 There is a clear need for standardized assessment of postoperative renal function.…”

Section: Renal Systemmentioning

confidence: 99%

Standardizing Clinical End Points in Aortic Arch Surgery

et al. 2014

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1610S ince the introduction of hypothermic circulatory arrest for aortic arch surgery in 1975, 1 there has been considerable progress in addressing this complex surgical pathology. [2][3][4] However, the rapidity with which operative techniques have evolved has outpaced methodical appraisal of their clinical merit, leaving behind a wealth of perfunctory data. In particular, existing emphasis on neurological outcomes has neglected other critical end points, whereas inconsistent definitions and reporting formats limit the applicability of the results of some studies. Robust comparisons between institutional reports are therefore difficult, restricting critical appraisal and summary of existing surgical approaches.The International Aortic Arch Surgery Study Group (IAASSG) has been formed to enable multi-institutional collaboration to better explore the impact of surgical techniques on patient outcomes, using uniform definitions of events and clinical end points. A key endeavor is to standardize reporting formats to facilitate effective comparisons. Such a concerted effort, with the combined expertise of leading academic surgeons, paves the way for a unified language specific for aortic arch surgery that promotes closer cooperation and systematic evaluation and is essential in forming a framework of existing knowledge and guiding progress and research for the future. 5,6The IAASSG has devised a management-orientated classification system for significant clinical end points specific for aortic arch surgery and has undertaken a consensus survey of leading arch surgeons. The following report describes this classification scheme and reports the results of the consensus. Methodology Rationales of the Grading SystemA management-oriented classification system for complications, which grades adverse events by severity on the basis of the management required, is simple, reproducible, and comprehensive.7 It avoids duplication of overlapping results and limits the fluctuating ratings of negative outcomes between institutions by providing standardized definitions. 7,8 Stratifying the severity of relevant complications into grades allows more thorough analysis to be achieved to assist benchmarking of existing procedures, identifying areas in need of improvement, guiding prospective research, and evaluating the effectiveness of interventions. Such an approach has been used widely 7 and has been successfully validated by several subspecialties and procedures. [9][10][11][12][13][14] Variants of this approach have also been implemented for thoracic surgery, resulting in a feasible system that facilitates objective assessments and identifies the burden of individual complications. 15,16 Following the work by Dindo and coworkers, 7 we propose the following system for grading adverse outcomes specific for aortic arch surgery (Table 1). Clinical complications are stratified into 5 major grades, from those that are self-limiting or

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“…Although a deep hypothermic circulatory arrest is an established method in the ield of aortic arch operations, there are concerns that the extremely low temperature can lead to adverse outcomes, such as hypothermia-related coagulopathy [23,24], prolonged periods of cardiopulmonary bypass, or direct hypothermic neuronal injury [25][26][27]. In addition, the introduction of adjunctive cerebral perfusion techniques, such as retrograde and antegrade cerebral perfusion has allowed continued perfusion and cooling of the brain after systemic circulatory arrest.…”

Section: Eeg Indings During Moderate Hypothermic Circulatory Arrestmentioning

confidence: 99%

Intraoperative Electroencephalography During Aortic Arch Surgery

Murashita¹

2017

Electroencephalography

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Since its introduction, deep hypothermic circulatory arrest has been widely used for cerebral protection during aortic arch surgery. The use of electroencephalogram plays an important role in intraoperative neurophysiologic monitoring. Systemic cooling to the point of electrocerebral inactivity has been thought to ensure optimal neuroprotection from the ischemic injury during circulatory arrest. Therefore, electroencephalogram can guide surgeons to induce deep hypothermic circulatory arrest at an optimal timing. In the meantime, along with the advent of adjunctive cerebral perfusion techniques, there is a certain trend that circulatory arrest is induced at higher degrees than traditional deep hypothermic approach, called moderate hypothermic circulatory arrest. The role of electroencephalogram in this approach has not been well established yet, but some studies suggested the importance of intraoperative electroencephalogram in this approach as well. Electroencephalogram is also utilized in emerging operative techniques called hybrid arch repair. To conclude, intraoperative use of electroencephalogram can greatly contribute to cerebral protection in the ield of aortic arch surgery, and surgeons should be familiar with its mechanism, indication, and interpretation.

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Hemiarch Replacement at 28°C: An Analysis of Mild and Moderate Hypothermia in 500 Patients

Cited by 68 publications

References 13 publications

Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection

Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection

Standardizing Clinical End Points in Aortic Arch Surgery

Intraoperative Electroencephalography During Aortic Arch Surgery

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