Retrograde cerebral perfusion for brain protection in aortic aneurysm surgery

Mishra, Pankaj Kumar; Bhan, Anil; Sharma, Rajesh; Kiran, Usha; Gupta, Rajeev; Venugopal, Panangipalli

doi:10.2459/jcm.0b013e32831897e2

Cited by 6 publications

(6 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During aortic arch surgery, different perfusion methodologies have been used to obtain cerebral protection: hypothermic circulatory arrest (HCA), retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP) [1][2][3] . Experimental and clinical work on cerebral protection during this type of surgery represents a topical subject 4 .…”

Section: Methodsmentioning

confidence: 99%

Open aortic arch surgery: how to reduce air embolism risk during antegrade cerebral perfusion

Lentini

Gaeta

2010

Perfusion

View full text Add to dashboard Cite

Antegrade cerebral perfusion (ACP) is used widely, with the aim of obtaining cerebral protection during open aortic arch surgery. ACP is considered by many to be the reason for improvements in the clinical outcome of this type of surgery. However, perioperative cerebral complications may still occur. Cerebral complications during ACP are considered to be due mainly to embolic events rather than hypoperfusion. We believe that many of the embolic events during ACP may be due to air embolism rather than to vessel manipulation only. To reduce the risk of air embolism during ACP, we propose an easy technique, with the suggested steps to be followed in an exact sequence.

show abstract

Section: Methodsmentioning

confidence: 99%

Open aortic arch surgery: how to reduce air embolism risk during antegrade cerebral perfusion

Lentini

Gaeta

2010

Perfusion

View full text Add to dashboard Cite

show abstract

“…At the end of the DHCA/RCP period, cerebral flow is initiated again via the arterial line. Nevertheless, RCP is maintained for another 5 min and stopped only after complete de-airing of the aortic arch 31,32 .…”

Section: Retrograde Cerebral Perfusionmentioning

confidence: 99%

“…It has been shown, recently, that RCP in combination with DHCA provides good cerebral protection when used for short intervals (22 ± 6 min) in ATAAD repair 31 ; it is simple to establish, offers an operation field free of cannulae and lowers the risk of stoke by avoidance of direct cannulation of possibly damaged supraaortic vessels. Otherwise, it has been demonstrated earlier, in both experimental and clinical studies, that prolonged periods of RCP may result in a substantial ICP increase and a pronounced cerebral edema 3 .…”

Section: Retrograde Cerebral Perfusionmentioning

confidence: 99%

See 1 more Smart Citation

State of the art in neuroprotection during acute type A aortic dissection repair

et al. 2011

View full text Add to dashboard Cite

show abstract

“…Differing results are being reported concerning the risks and benefits of retrograde cerebral perfusion: experimental studies reported worsened cerebral edema after retrograde perfusion, 35 whereas others obtained different results. 36 A recent study found it to improve neurological outcome after extended durations of circulatory arrest, 37 whereas others have demonstrated no beneficial effect on neurological outcome after aortic surgery. 38 During surgery, cerebral perfusion is determined largely by systemic blood pressure, for which the optimal range during cardiac surgery has not been determined.…”

Section: Avoiding Stroke By Improved Perfusionmentioning

confidence: 99%

Avoiding Stroke During Cardiac Surgery

Kellermann

Jungwirth

2010

Semin Cardiothorac Vasc Anesth

View full text Add to dashboard Cite

The life saving benefits of cardiac surgery are frequently accompanied by negative side effects such as stroke, that occurs with an incidence of 2%-13% dependent to type of surgery. The etiology is most likely multifactorial with embolic events considered as main contributor. Although stroke presents a common complication, no guidelines for any routine use of pharmacological substances or non-pharmacological strategies exist to date. Non-pharmacological strategies include monitoring of brain oxygenation and perfusion with devices such as near infrared spectroscopy and Transcranial Doppler help. Epiaortic and transesophageal echocardiography visualize aorta pathology, enabling the surgeon to sidestep atheromatous segments. Additionally can the use of specially designed aortic cannulae and filters help to reduce embolization. Brain perfusion can be improved by using antero- or retrograde cerebral perfusion during deep hypothermic circulatory arrest, by tightly monitoring mean arterial blood pressure and hemodilution. Controlling perioperative temperature and glucose levels may additionally help to ameliorate secondary damage. Many pharmacological compounds have been shown to be neuroprotective in preclinical models, but clinical studies failed to confirm these results so far. Remacemide, an NMDA-receptor-antagonist showed a significant drug-based neuroprotection during cardiac surgery. Other substances currently assessed in clinical trials whose results are still pending are acadesine, an adenosine-regulating substance, the free radical scavenger edaravone and the local anesthetic lidocaine. Stroke remains as significant complication after cardiac surgery. Non-pharmacological strategies allow perioperative caregivers to detect injurious events and to ameliorate stroke and its sequelae. Considering the multi-factorial etiology though, stroke prevention will likely have to be addressed with an individualistic combination of different strategies and substances.

show abstract

Retrograde cerebral perfusion for brain protection in aortic aneurysm surgery

Abstract: A major limitation of DHCA is the time constraint imposed, beyond which DHCA in isolation may not be safe. Considering the simplicity and safety involved, more liberal use of retrograde cerebral perfusion as an adjunct to DHCA is advocated.

Cited by 6 publications

References 17 publications

Open aortic arch surgery: how to reduce air embolism risk during antegrade cerebral perfusion

Open aortic arch surgery: how to reduce air embolism risk during antegrade cerebral perfusion

State of the art in neuroprotection during acute type A aortic dissection repair

Avoiding Stroke During Cardiac Surgery

Contact Info

Product

Resources

About