Selective cerebral perfusion with 4-branch graft total aortic arch replacement: Outcomes in 12 patients

Abstract

Background Aortic arch reconstruction is associated with high neurological morbidity. Our purpose is to describe our experience using a 4-branched graft and selective antegrade brain perfusion (SABP) for total aortic arch replacement (TAR). Methods We retrospectively reviewed the medical records of 12 patients who received TAR, with or without ascending aorta replacement, with a 4-branched graft for Stanford type A dissection ( n = 9) or aortic arch aneurysm ( n = 3). In all patients surgery was performed with deep hypothermic circulatory arrest (DHCA) with or without retrograde brain perfusion, and selective antegrade brain perfusion (SABP) via the subclavian artery or axillary artery. Results There were 8 males and 4 females with an average age of 63.14 years. Emergent operations were performed in 9 patients with acute type A aortic dissections. Of all 12 patients, 2 deaths occurred and 1 patient experienced lower extremity paraplegia resulting in an in-hospital mortality rate of 16.6% and a permanent neurological deficit rate of 8.3%. Conclusions The use of a 4-branched graft, hypothermic circulatory arrest, and SABP is a useful operative method for aortic arch replacement with acceptable morbidity and mortality.

Evaluation of peripheral blood microsampling techniques in combination with liquid chromatography‐high resolution mass spectrometry for the determination of drug pharmacokinetics in clinical studies

“…For the last 50 years, acetaminophen (N‐acetyl‐ p ‐amino‐phenol, ACP) – also known under the name of paracetamol – has been one of the most widely used antipyretic and analgesic medications worldwide . The drug is used for effective pain relief.…”

“…The bioanalytical method's accuracy and precision were improved in comparison with conventional DBS sampling. ACP concentrations have been quantitatively analyzed by using a variety of assays applying different biological fluids such as blood, plasma, urine, and saliva …”

“…For the last 50 years, acetaminophen (N-acetyl-p-amino-phenol, ACP)also known under the name of paracetamolhas been one of the most widely used antipyretic and analgesic medications worldwide. [1] The drug is used for effective pain relief. Although, ACP is much prescribed, the drug's mode of action is not yet completely understood; it appears that ACP's pharmacological action is related to the inhibition of a number of cyclooxygenase enzyme isoforms in the central nervous system.…”

“…ACP concentrations have been quantitatively analyzed by using a variety of assays applying different biological fluids such as blood, plasma, urine, and saliva. [1,46,47] The PK of ACP is well studied in different biological matrices; [46] however, only a few limited papers report the application of microsampling techniques for ACP PK studies. The most applied analytical technique for the quantitative measurement of ACP concentration levels in biological fluids is liquid chromatography (LC) in combination with different detectors such as ultraviolet (UV), [48,49] UV in combination with electrochemical detection (ED), [50] fluorescence detection (FD), [51] and MS detection, [32,52] although spectrophotometry can also be applied.…”

False traumatic aneurysm of the aortic arch. Retrograde cerebral perfusion obliged. A case report

“…1 The basic technique of cerebral protection is deep hypothermic circulatory arrest, which can (or cannot) be combined with selective anterior perfusion or retrograde cerebral perfusion (RCP). 2,3 The best results are obtained by combining moderate hypothermic circulatory arrest and selective anterior perfusion. 3,4 We present a patient who received an RCP.…”