Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: A risk factor analysis for adverse outcome in 501 patients

Khaladj, Nawid; Shrestha, Malakh; Meck, Sara; Peterß, Sven; Kamiya, Hiroyuki; Kallenbach, Klaus; Winterhalter, Michael; Hoy, Ludwig; Haverich, Axel; Hagl, Christian

doi:10.1016/j.jtcvs.2007.07.067

Cited by 196 publications

(134 citation statements)

References 32 publications

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“…The Stroke rate, cardiopulmonary bypass, cross clamp, post op ventilator times and ICU and hospital lengths of stay were all reduced in the 28.5˚C group (Table 2) (59). We feel that these results add to the growing body of literature which supports the strategy of moderate hypothermic circulatory arrest + uSACP as a highly effective cerebral protection strategy for aortic arch replacement (36,54,55,56).…”

Section: Moderate Hypothermiamentioning

confidence: 53%

“…There were no significant differences between the three groups with regards to the incidence of mortality, PND or TND (54). The use of MHCA+ACP for arch reconstruction has also been reported by several groups in the setting of acute Type A aortic dissection with results equivalent to those achieved with DHCA (55,56,57). At Emory, MHCA+uSACP is our preferred method of cerebral protection.…”

Section: Moderate Hypothermiamentioning

confidence: 62%

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Cerbral Protection Strategies for

Leshnower¹,

Chen²

2012

Front Lines of Thoracic Surgery

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Section: Moderate Hypothermiamentioning

confidence: 53%

Section: Moderate Hypothermiamentioning

confidence: 62%

Cerbral Protection Strategies for

Leshnower¹,

Chen²

2012

Front Lines of Thoracic Surgery

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“…(15) 501 hastada yayımladığı retrospektif bir çalışma-da, hipotermik sirkülatuar arrest ile birlikte selektif antegrad serebral perfüzyon uygulanan hasta grubunda yaş, reoperasyon, femoral arter kanülasyon ve CPB sü-resinin mortaliteyi arttırıcı risk faktörleri olduğu belirtilmiştir. Çalışmamızda postoperatif dönemde intra aortik balon pompa (İABP) kullanımı, kalp yetmezliği, atrium ritim bozukluklarının mortalite için bağımsız risk faktörleri olduğu saptandı (% 95 güven aralığında; Hosmer and Le-Şekil 2.…”

Section: Discussionunclassified

The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and Survival

Baysal¹,

Doğukan²,

Temel³

et al. 2012

JTAICS

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ÖZETAmaç: Aort anevrizma onarım operasyonlarında farklı cerrahi kanülasyon teknikleri, ısı regülasyonu ve beyin koruma yöntemlerinin mortalite üzerinde etkili perioperatif risk faktörleri ile ilişkisinin incelenmesini amaçladık. Bu nedenle; derin hipotermik sirkulatuar arrest (DHSA) ve retrograd serebral perfüzyon (RSP) altında femoral veya aortik kanülasyon ile uygulanan hastalar, orta derecede hipotermik sirkulatuar arrest (OHSA) ve selektif antegrad serebral perfüzyon (SASP) altında aksiller kanülasyon uygulanan hastalar karşılaştırıldı.Gereç ve Yöntem: Aortik ark anevrizma onarım operasyonu olan 110 ardışık hasta prospektif nonrandomize bir çalışma planı içeri-sinde üç ayrı gruba cerrahi patoloji, operasyon ve anestezi tekniklerine dayanılarak ayrıldı. Grup 1'de; femoral kanülasyon, DHSA (22-25°C), ve RSP uygulanırken, Grup 2'de; aksiller kanülasyon, OHSA ve SASP, Grup 3'te; aortik kanülasyon, DHSA ve RSP uygulandı. Perioperatif risk faktörleri araştırıldı.Bulgular: Üç grup karşılaştırıldığında kros klamp ve kardiyopulmoner baypas (KPB) süreleri (dk.) farklı idi (Grup 1'de; 75,62±26,28 ve144,15±66,71, Grup 2'de; 60,57±26,32 ve 109,09±45,38, Grup 3'te; 72,90±23,33 ve 120,83±53,46 sırası ile p=0,021). Mortalite hızlarının karşılaştırması; Grup 1'de 10/34 (% 29,4), Grup 2'de 3/47 (% 6,4) ve Grup 3'te 3/29 (% 10,3) (p=0,011) hasta olduğunu gösterdi. IABP kullanımı, kalp yetmezliği, atrial ritim bozukluklarının mortalite için bağımsız risk faktörleri olduğu saptandı (% 95 gü-ven aralığında; Hosmer and Lemeshow testi, ki kare=5,71 ve p=0,68).Sonuç: OHSA, SASP ve aksiller kanülasyon ile aortik ark anevrizma onarımı geçiren hastalarda morbidite ve mortalite DHSA, RSP ve femoral veya aortik kanülasyon yapılan hastalar ile karşılaştırıldığında daha az oranda gözlenmektedir.Anahtar kelimeler: Aortik anevrizma, derin hipotermik sirkülatuar arrest, orta derecede hipotermik sirkulatuar arrest SUMMARY The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and SurvivalObjective: Our aim was to investigate the relation between perioperative risk factors influencing mortality and different methods of surgical cannulation, temperature regulation and cerebral protection in patients undergoing aortic aneurysm repair surgery. For this purpose; patients requiring deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and femoral or aortic cannulation were compared with patients requiring axillary cannulation, moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).Material and Methods: 110 consecutive patients undergoing aortic arch aneurysm repair surgery were divided into three groups in a prospective, nonrandomized study plan depending on surgical pathology, operation and anesthesia techniques. In Group 1, femoral cannulation, DHCA (22-25°C) and RSP ; in Group 2, axillary cannulation, MHCA (26-28°C) and SACP, whereas, in Group 3, aortic cannulation, DHCA and RCP were per...

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“…The main drawback of ACP is the possibility of cerebral embolisms, by arterial manipulation Currently ACP is the most commonly used technique for aortic surgery in most hospitals (23,48,49), for its good results (50), and it can increase the safety time to more than 80 minutes (51). It is also described in a propensity matched analysis a reduction of neurological complications and a tendency to lower mortality at 30 days with ACP (52).…”

Section: Retrograde Versus Acpmentioning

confidence: 99%

Intraoperative care for aortic surgery using circulatory arrest

et al. 2017

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Abstract:The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20.1-28 ℃) associated with unilateral or bilateral selective cerebral perfusion methods. In this way the neurological results are better, the interval of security is greater and the times of extracorporeal circulation are smaller. Even so, it is necessary to take into account that there is the possibility of ischemia in the lower part of the body, especially of the abdominal viscera and the spinal cord, therefore the time of circulatory stop should be limited and not to exceed 80 minutes. Evidence of possible neurological drug protection is very weak and only mannitol, magnesium, and statins can produce some benefit. Inhalational anesthetics and some intravenous seem to have advantages, but more studies would be needed to test their long-term benefit. Other important parameters to be monitored during these procedures are blood glucose, anemia and coagulation disorders and acid-base balance. The recommended monitoring is common in complex cardiovascular procedures and it is of special importance the neurological monitoring that can be performed with several techniques, although currently the most used are Bispectral Index (BIS) and Near-Infrared Spectroscopy (NIRS). It is also essential to monitor the temperature routinely at the nasopharyngeal and bladder level and it is important to control coagulation with rotational thromboelastometry (ROTEM).

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Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: A risk factor analysis for adverse outcome in 501 patients

Cited by 196 publications

References 32 publications

Cerbral Protection Strategies for

Cerbral Protection Strategies for

The Effects of Different Methods Applied for the Protection of Myocardial and Brain Functions During Aortic Aneurysm Repair Surgery on the Prognosis and Survival

Intraoperative care for aortic surgery using circulatory arrest

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