Hypothermic bypass and circulatory arrest for operations on the descending thoracic and thoracoabdominal aorta

Un niveau réduit d’hématocrite aggrave les lésions cérébrales après un arrêt circulatoire hypothermique prolongé chez le rat

“…[16][17][18][19][20] Although many improvements have been introduced since the technique was first established, there remain recognized complications secondary to unique physiologic trespasses associated with HCA and CPB. [19][20][21][22] Further refinements of the technique require an appropriate experimental model.…”

Diretrizes para o tratamento cirúrgico das doenças da aorta da Sociedade Brasileira de Cirurgia Cardiovascular

“…The surgical approach in descending aortic dissections normally consists of the replacement of the affected portion using a tubular Dacron graft by left thoracotomy through the 4 th or 7 th intercostal spaces, which can be performed with simple proximal clamping [61,62] with atrial-femoral CPB either with or without hypothermia [63-66], partial femurfemoral CPB [67] or even using CCA under deep hypothermia for a proximal open anastomosis [68]. Depending on the chosen technique, the dose of heparin and the effects of the hypothermia level in the cascade of coagulation could determinate variable effects on the hemostasis or in the production of dyscrasia.…”

“…While Kouchoukos et al [68] supported by incidences of 6.5% for paraplegia and of 10% for death over 30 days, recommended total CPB with CCA under deep hypothermia, Crawford et al [154] considered this technique particularly useful in aneurysms that involve part of the arch or in arches extensively calcified in their proximal portions, presenting paraplegia and mortality rates of 9.5% and 16% respectively.…”

Diretrizes para a cirurgia das doenças da aorta

“…A abordagem cirúrgica nas DA de aorta descendente, habitualmente, consiste na substituição da porção afetada por um enxerto tubular de dacron, através de toracotomia esquerda no 4º e/ou 7º espaço intercostal, o que pode ser realizado com clampeamento simples proximal 63,64 , com CEC átrio-femoral com ou sem hipotermia [65][66][67][68] , CEC parcial fêmuro-femoral 69 , ou até mesmo com uso da PCC sob hipotermia profunda para uma anastomose proximal aberta 70 .…”

“…Enquanto Kouchoukos e cols., 70 suportados por incidência de 6,5% de paraplegia e de 10% de óbito em 30 dias, recomendam rotineiramente a CEC total com PCC sob hipotermia profunda, Crawford e cols. 158 consideram esta técnica particularmente útil em aneurismas que envolvem parte do arco, ou extensamente calcificados em sua porção proximal, apresentando taxas de paraplegia e mortalidade, de 9,5% e 16%, respectivamente.…”