Selective antegrade cerebral perfusion via right axillary artery cannulation reduces morbidity and mortality after proximal aortic surgery

Halkos, Michael E.; Kerendi, Faraz; Myung, Richard J.; Kilgo, Patrick D.; Puskas, John D.; Chen, Edward P.

doi:10.1016/j.jtcvs.2009.07.045

Cited by 121 publications

(107 citation statements)

References 22 publications

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“…However, we concern the possible complications of retrograde perfusion such as retrograde cerebral embolization or organ malperfusion. 4,6) Our policy is that we manage to establish antegrade aortic perfusion as possible as we can because of establishment of antegrade aprtic perfusion and prevention of concerned complications.…”

Section: Discussionmentioning

confidence: 99%

“…This technique has been applied to a repair of AAD and effective circulation management could be achieved by Comas et al 2) Controversy that which arterial cannulation site is optimal in a repair of AAD exists. 4,5) Femoral artery is the usual cannulation site for cardiopulmonary bypass in a repair of AAD, 6) on the other hand, the retrograde perfusion via the femoral artery causes retrograde thromboembolism from atheromatous debris in the thoracic and was performed in 34 patients. Mean age was 64.5 ± 13.7 years of age.…”

Section: Introductionmentioning

confidence: 99%

“…4,6) In contrast, the use of the right axillary artery can provide not only antegrade aortic perfusion during cardiopulmonary bypass but also continuous antegrade cerebral perfusion during circulatory arrest. 4,6,7) Our current strategy of arterial perfusion is the right axillary artery perfusion with an 8-mm prosthetic graft in a repair of AAD. In this study, we aim to investigate operative outcomes in our strategy of arterial perfusion in a repair of AAD and whether the duration of ACP affects early outcomes.…”

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confidence: 99%

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Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

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IntroductionType A acute aortic dissection (AAD) is still a devastating disease, which mortality rate following medical managements reaches to 50% within the first 48 h. 1) The mortality rate associated with AAD after surgery has decreased, but it reached to roughly 20% worldwide. 2) In Japan, hospital mortality rate after an emergency surgery for AAD was 9.2% in 2010. 3) Antegrade cerebral perfusion (ACP) is one of the techniques for cerebral protection during proximal aortic surgery. This technique has been applied to a repair of AAD and effective circulation management could be achieved by Comas et al. 2) Controversy that which arterial cannulation site is optimal in a repair of AAD exists. 4,5) Femoral artery is the usual cannulation site for cardiopulmonary bypass in a repair of AAD, 6) on the other hand, the retrograde perfusion via the femoral artery causes retrograde thromboembolism from atheromatous debris in the thoracic and was performed in 34 patients. Mean age was 64.5 ± 13.7 years of age. Preoperative shock status was in three due to cardiac tamponade. Organ malperfusion occurred in 11 patients preoperatively. Mean follow-up period was 9.6 ± 8.4 months and follow-up rate was 100%. Results: Hospital mortality rate was 8.8%. No newly required hemodialysis and new onset of temporary or permanent neurologic deficits were present in survivors. There were no statistically significant differences of mortality rate, new onset of permanent or temporary neurologic deficits and distal organ dysfunction between ACP duration <60 min and ≥60 min. The 12-month survival was 84.4% ± 6.4%. And, freedom from aorta-related events at 12 and 18 months were 100% ± 0.0% and 88.9% ± 10.5%, respectively. Conclusions: The duration of ACP via right axillary artery does not affect early outcomes following a repair of AAD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Prolonged Antegrade Cerebral Perfusion via Right Axillary Artery (≥60 min) Does Not Affect Early Outcomes in a Repair of Type A Acute Aortic Dissection

Fukunaga

Saji

Kanemitsu

et al. 2015

ATCS

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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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“…In bSACP, there is a risk of cannulation-induced embolic injury from the introduction of cerebral perfusion catheters into the innominate and left common carotid arteries, especially in patients with atheromatous aortic arch disease. With uSACP, the innominate artery is occluded at the time of circulatory arrest and antegrade blood at 16°C is perfused at 10ml/kg/min through the right common carotid artery, right vertebral artery as well as through the left carotid system via intracranial and extracranial collaterals (58). This avoids manipulation of the ostia of the great vessels which are often covered with large, friable atherosclerotic plaques.…”

Section: Moderate Hypothermiamentioning

confidence: 99%