Moderate Hypothermia and Unilateral Selective Antegrade Cerebral Perfusion: A Contemporary Cerebral Protection Strategy for Aortic Arch Surgery

Leshnower, Bradley G.; Myung, Richard J.; Kilgo, Patrick D.; Vassiliades, Thomas A.; Vega, Julián; Thourani, Vinod H.; Puskas, John D.; Guyton, Robert A.; Chen, Edward P.

doi:10.1016/j.athoracsur.2010.03.118

Cited by 107 publications

(98 citation statements)

References 21 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: 83%

“…When using MHCA, ACP must be employed as it is the only adjunctive method reported with more moderate levels of hypothermia. Animal studies have demonstrated equivalent bilateral perfusion with the use of uSACP or bSACP, and clinical data has reported excellent neurologic outcomes with either method (43,54,55,57). Surgeons should be familiar with the technical aspects of all of these different methods of cerebral protection.…”

Section: Resultsmentioning

confidence: 99%

“…There was a 4.6% incidence of renal failure requiring dialysis. In a multivariate analysis, moderate hypothermia was not found to be an independent risk factor for mortality, PND, TND or renal failure requiring dialysis (55). Since that initial report, our experience has grown and we have continued to perform arch reconstructions at more moderate levels of hypothermia.…”

Section: Moderate Hypothermiamentioning

confidence: 94%

“…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: 95%

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Cerbral Protection Strategies for

Leshnower¹,

Chen²

2012

Front Lines of Thoracic Surgery

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Section: Moderate Hypothermiamentioning

confidence: 83%

Section: Resultsmentioning

confidence: 99%

Section: Moderate Hypothermiamentioning

confidence: 94%

Section: Moderate Hypothermiamentioning

confidence: 95%

See 2 more Smart Citations

Cerbral Protection Strategies for

Leshnower¹,

Chen²

2012

Front Lines of Thoracic Surgery

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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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Circulatory Arrest and Cerebral Protection Strategies

Tarola

Chu

2020

Evidence-Based Practice in Perioperative Cardiac Anesthesia and Surgery

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Moderate Hypothermia and Unilateral Selective Antegrade Cerebral Perfusion: A Contemporary Cerebral Protection Strategy for Aortic Arch Surgery

Cited by 107 publications

References 21 publications

Cerbral Protection Strategies for

Cerbral Protection Strategies for

Intraoperative care for aortic surgery using circulatory arrest

Circulatory Arrest and Cerebral Protection Strategies

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