Neurologic outcome after surgery of the aortic arch: Comparison of deep hypothermic arrest, antegrade and retrograde cerebral perfusion

Abstract

Introduction: Neurologic deficits are still a major complication of aortic arch surgery. We therefore compared cerebral protection by deep hypothermic circulatory arrest (DHCA), antegrade (ACP) and retrograde (RCP) cerebral perfusion.Patients and Method: 64 consecutive patients who underwent replacement of the aortic arch for aneurysms or dissections from January 1999 through August 2001 were analysed retrospectively for clinical and neurologic outcome. For DHCA core temperature was lowered to 18~ and was kept between 18 and 24~ in the perfused groups. Selective antegrade cerebral perfusion (ACP) was achieved either via the subclavian artery or the brachiocephalic trunc. Retrograde cerebral perfusion (RCP) was performed via the superior vena cava.

Antegrade Versus Retrograde Cerebral Perfusion in Relation to Postoperative Complications Following Aortic Arch Surgery for Acute Aortic Dissection Type A

“…The incidence of postoperative neurological dysfunction is expressed as permanent neurological dysfunction (PND) or temporary neurological dysfunction (TND). It varies between 5.5% and 33.3%, depending on the above mentioned factors, as well as the method of brain protection 3,6–13 . The deep hypothermic circulatory arrest (DHCA) alone or in combination with continuous cerebral perfusion (ante‐ or retrograde) are nowadays the established methods of brain protection in aortic arch surgery.…”

“…It varies between 5.5% and 33.3%, depending on the above mentioned factors, as well as the method of brain protection. 3,[6][7][8][9][10][11][12][13] The deep hypothermic circulatory arrest (DHCA) alone or in combination with continuous cerebral perfusion (ante-or retrograde) are nowadays the established methods of brain protection in aor-tic arch surgery. The superiority of antegrade or retrograde cerebral perfusion (RCP) has been debated for many years.…”

Neuroprotective Strategies in Repair and Replacement of the Aortic Arch

“…76,86,[166][167][168][169][170][171] A significant weakness of this body of literature is that the majority of studies to date have been retrospective and/or limited in the number of patients included. 67,169,172 Additionally, improvements in techniques over time and lack of adequate controls make comparisons between studies difficult. 86,167 To date, there have been five publications regarding prospective, randomized trials to compare ACP and RCP.…”

Study of hypothermia on cultured neuronal networks using multi-electrode arrays

“…The therapeutic effects of hypothermia in reducing cerebral injury are well documented (Barone et al, 1997;Muller et al, 2004). Low temperature is now routinely used in surgical procedures, such as deep hypothermic circulatory arrest (DHCA) where the body and brain temperature of patients are lowered to 18-20 • C, allowing for "safe" ischemic windows of approximately 60 min (Kumral et al, 2001;Bissonnette et al, 1999;Myron, 1989).…”

“…For instance, DHCA still results in up to 10% of patients having documented postoperative neurological morbidities, including dysfunction in memory and learning (Muller et al, 2004;Bissonnette et al, 1999;Myron, 1989). Furthermore, while low temperature has a beneficial effect on protecting the injured or treated brain, an extended period of hypothermia can by itself result in health complications including apoptosis and necrosis of neurons (Bell et al, 1989;Ditsworth et al, 2003).…”