Improved results for dissecting aneurysms

Gm, Lemole; strong,; Pm, Spagna; Np, Karmilowicz

doi:10.1016/s0022-5223(19)37304-0

Cited by 137 publications

(5 citation statements)

References 8 publications

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“…RCP was introduced by Mills and Ochner to treat iatrogenic air embolism in 1980 [ 22 ]. Lemole and colleagues were the first to describe its use in ATAAD in 1982 but administered it intermittently every 20 min during HCA rather than continuously [ 12 ]. The first use of continuous flow RCP was described by Ueda and colleagues in 1990 [ 15 ], but despite being used for more than 30 years, the exact mechanism of action of RCP is not fully understood.…”

Section: Discussionmentioning

confidence: 99%

“…During this procedure, deep hypothermia is induced to protect the cerebral parenchyma from ischemia as circulatory arrest is required for the completion of the distal anastomosis. As an adjunct to hypothermic circulatory arrest (HCA), retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP) have been introduced, potentially reducing the risk of ischemic injuries, especially in cases with expected prolonged HCA duration [ 12 – 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest

Ede,

Teurneau-Hermansson,

Ramgren

et al. 2024

J Cardiothorac Surg

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Background To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection. Methods Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was performed to identify independent predictors of the primary outcomes. Survival analysis was performed using Kaplan-Meier estimates. Results Clinical neurological injury and embolic lesions were less frequent in patients with retrograde cerebral perfusion (20.2% vs. 28.4%, p = 0.041 and 13.7% vs. 23.4%, p = 0.010, respectively), but there was no significant difference in the occurrence of watershed lesions (3.0% vs. 6.1%, p = 0.156). However, after multivariable logistic regression, retrograde cerebral perfusion was associated with a significant reduction of clinical neurological injury (OR: 0.60; 95% CI 0.36–0.995, p = 0.049), embolic lesions (OR: 0.55; 95% CI 0.31–0.97, p = 0.041), and watershed lesions (OR: 0.25; 95%CI 0.07–0.80, p = 0.027). There was no significant difference in 30-day mortality (12.8% vs. 11.7%, p = ns) or long-term survival between groups. Conclusion In this study, we showed that the addition of retrograde cerebral perfusion during hypothermic circulatory arrest in the setting of acute type A aortic dissection repair reduced the risk of clinical neurological injury, embolic lesions, and watershed lesions.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest

Ede,

Teurneau-Hermansson,

Ramgren

et al. 2024

J Cardiothorac Surg

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“…A ringed intra-luminal prosthesis held in place by external encircling tapes has been recommended as an alternative means of avoiding anastomotic difficulties. 26 • 27 However, it may be cumbersome to use in the ascending aorta and may compromise right coronary artery flow. It is more likely to have a role in the descending aorta, but the long-tenn fate of this ringed prosthesis is unknown.…”

Section: Proximal Dissectionmentioning

confidence: 99%

Aortic Dissection

Ponraj

Pepper

1992

Int J Clinical Practice

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SUMMARYAortic dissection, once thought to be rare, is the most common catastrophe of the aorta, being twice as common as ruptured abdominal aortic aneurysm.1 In one Inner London borough, aortic dissection accounted for 4.2% of sudden deaths in men over a three‐year period.2 Early diagnosis and prompt treatment are crucial to achieving a successful outcome, because the events that influence survival occur early in the course of the disease.Surgical repair of aortic dissection is an uncommon operation in the United Kingdom. The Cardiac Surgical Register for 1988 (the most recent year available for analysis) reveals that 208 operations were performed to replace the ascending aorta, 12 operations to replace the aortic arch and 15 operations on the descending aorta during that year.

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“…In 1982, Lemole et al [2] published intermittent RCP as a method to improve cerebral oxygen delivery during operations using hypothermic cardiac arrest (HCA). They reported using profound hypothermia for cardiac arrest (CA) and prolonging it by an intermittent retrograde perfusion via the superior vena cava for 2 min out of every 10, providing in the way cerebral oxygenation during this period with decreased risk for neurological sequel and bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…Retrograde cerebral perfusion via cannulation of the superior vena cava is a widespread method [5] and was described as a promising method by many authors [1,2,4,[6][7][8][9] for optimising protection of the brain during hypothermic circulatory arrest, which is necessary for the surgery of the ascending and/or transverse aortic arch, and for acute type A aortic dissection. This technique is easy to handle and compared with anterograde cerebral perfusion through the open aorta, there might be an important exposure advantage and no need of a risky direct cannulation of a dissected vessel for repair of dissecting aortic aneurysm.…”

Section: Introductionmentioning

confidence: 99%

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

Künzli

Zingg

Zünd

et al. 2006

European Journal of Cardio-Thoracic Surgery

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As a rule, anatomically and functionally competent valves in the proximal IJV are present. In human beings, they obstruct the direct retrograde inlet to the intracranial venous system, which suggests an unbalanced and unreliable perfusion of the brain. Therefore, retrograde cerebral perfusion by cannulating the superior vena cava may help flushing out embolism and supporting 'the cold jacket' of the brain. However, its effect of retrograde backflow cannot be a sign of adequate cerebral perfusion.

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Improved results for dissecting aneurysms

Cited by 137 publications

References 8 publications

Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest

Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest

Aortic Dissection

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

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