Totally normothermic aortic arch replacement without circulatory arrest

Touati, Gilles; Roux, Nicolas; Carmi, Doron; Degandt, Alexandra; Benamar, A.; Marticho, Paul; Nzomvuama, Alphonse; Poulain, H

doi:10.1016/s0003-4975(03)00739-2

Cited by 22 publications

(12 citation statements)

References 6 publications

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“…Our results are compatible with the other studies. [18,19] Hypothermic circulatory arrest was used in 60.7% of our patients, which is similar to other axillary cannulation series like that of Neri et al [12] Touati et al [20] demonstrated that in aortic arch cases, axillary arterial cannulation may help the surgeon avoid the use of HCA. Although HCA exceeding 25 minutes has previously been associated with mortality, [21] we did not find a similar association in the logistic regression analysis.…”

Section: Discussionsupporting

confidence: 81%

Axillary artery cannulation in ascending aortic pathologies

Tuncer¹

2011

Turkish J Thorac Cardiovasc Surg

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Amaç: Bu çalışmada kardiyopulmoner bypass (KPB) için aksiller kanülasyonun sonuçları ve mortalite ve morbiditeye etki eden faktörler incelendi. Ça lış ma pla nı: Kasım 2006 -Ocak 2009 tarihleri arasında çıkan aort patolojileri nedeniyle ameliyata alınan 84 hasta (58 erkek, 26 kadın; ort. yaş 53.8±13.2 yıl; dağılım 20-77 yıl) aksiller kanülasyonla ameliyat edildi. Toplamda 84 hastaya 124 işlem uygulandı ve en sık uygulanan işlem 64 hastaya (%76.2) yapılan çıkan aort replasmanıydı. En sık ameliyat endikasyonu 51 hastada (%60.7) bulunan çıkan aort anevrizmasıydı. Üç hasta (%3.6) daha önce açık kalp ameliyatı geçirmişti. Hipotermik dolaşım arresti 51 hastada (%60.7) kullanıl-dı ve aksiller arter 75 hastada (%89.3) doğrudan, dokuz hastada (%10.7) ise bir yan greft aracılığıyla kanüle edildi. Bul gu lar: Ameliyat sonrasında hastaların üçünde (%3.6) sepsis, ameliyat sırası kanama ve düşük kardiyak debi sendromu nedeniyle hastane mortalitesi meydana geldi. Hastaların 10'unda (%11.9) nörolojik komplikasyonlar görüldü (8'inde geçici nörolojik disfonksiyon ve 2'sinde inme). Ortalama hastanede kalma süresi 5.1±5.6 (dağı-lım 1-46) gündü. Ameliyat sonrası ortalama takip süresi 10.3±5.5 (dağılım 1-15.5) aydı (toplam 68.5 hasta/yıl). Taburcu sonrası takip sürecinde mortalite görülmedi. Kanülasyon yöntemi ile mortalite ya da nörolojik komplikasyonlar arasında herhangi bir ilişki saptanmadı. So nuç:Aksiller arter arteriyel kanülasyon için güvenli bir yoldur ve aksiller yol ameliyat sonrası mortalite ve morbiditede artışa neden olmaz.Anah tar söz cük ler: Çıkan aort; aksiller arter kanülasyonu; selektif antegrad serebropleji. Background:We analyzed the results of axillary cannulation for cardiopulmonary bypass (CPB) and the factors affecting mortality and morbidity. Methods: Eighty-four patients (58 males, 26 females; mean age 53.8±13.2 years; range 20 to 77 years) were operated on for ascending aortic pathologies with axillary arterial cannulation between November 2006 and January 2009. Overall, 124 procedures were performed in 84 patients, and the most commonly performed procedure was the replacement of the ascending aorta which was employed in 64 patients (76.2%). The most common indication for operation was ascending aortic aneurysm that was present in 51 patients (60.7%). Three (3.6%) patients had previously undergone open heart surgery. Hypothermic circulatory arrest was used in 51 (60.7%) patients, and the axillary artery was cannulated directly in 75 (89.3%) patients and via a side graft in nine (10.7%) patients. Results: Postoperatively, three patients (3.6%) had in-hospital mortality because of sepsis, intraoperative bleeding, and low cardiac output syndrome. Neurological complications were seen in 10 (11.9%) patients (8 had transient neurological dysfunction and 2 had stroke). The mean duration of hospital stay was 5.1±5.6 (range 1 to 46) days. Postoperative follow-up was 10.3±5.5 (range 1 to 15.5) months on average (total of 68.5 patient/years). There was no mortality during the follow-up after discharge. No relationsh...

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Section: Discussionsupporting

confidence: 81%

Axillary artery cannulation in ascending aortic pathologies

Tuncer¹

2011

Turkish J Thorac Cardiovasc Surg

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“…Touati et al [27] published surgery outcomes involving aortic arch using cariopulmonary bypass under normothermia and without circulatory arrest in 29 patients. They reported inhospital mortality of 6.9% and neurologic sequela of 3.4%.…”

Section: Resultsmentioning

confidence: 99%

Cirurgia do arco aórtico com perfusão cerebral bilateral pelo isolamento do tronco braquiocefálico e da artéria carótida esquerda

Carreira

Oliveira²,

Honório

et al. 2008

Rev Bras Cir Cardiovasc

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“…Некоторые авторы пытались проводить основную и селективную перфузии при реконструкции дуги аорты в разных температурных режимах [14,15], но использо-вали нормотермию для перфузии тела, что не позволяло работать на открытой аорте в зоне дистального анасто-моза, а гипотермическая перфузия головного мозга могла приводить к его повреждению на этапе согревания [16,17]. Другие авторы предлагают методики реконструкции дуги аорты полностью на нормотермической перфузии без остановки кровообращения тела [18], однако эти ме-тодики не всегда выполнимы в определенных клиничес-ких ситуациях (острое расслоение аорты) и не позволя-ют удобно работать в зоне дистального анастомоза.…”

Section: Discussionunclassified

Change of paradigm in the aortic arch reconstruction – “warm head – cool body”

Россейкин¹,

Евдокимов²,

Базылев³

et al. 2016

PKiK

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Aim. The article focuses on the immediate outcomes of a new technology implemented in total reconstruction of the aortic arch and its branches. Methods. From January 2014 to July 2016 56 patients underwent aortic arch reconstruction by the proposed new technology. The age was from 23 till 73 years (median 57,5). Indications for aortic arch reconstruction were an aneurysm of the aortic arch (32 patients, 57 %), acute (8 patients, 14 %) and DeBakey Types 1 and 2 chronic dissection (16 patients, 29 %). The proposed technology of aortic arch reconstruction included four interrelated components: 1) total individual antegrade cerebral perfusion in the normothermic mode; 2) a system of two independent circuits of perfusion; 3) original method of prosthetic aortic arch branches in reverse order (“Opposite Branch First Technique”); 4) Penza aortic cannulation technique (“Penza Cannulation”). Results. No in-hospital mortality was observed. There were two cases of neurological deficit in the immediate postoperative period, associated with atrial fibrillation. CPB time was 177.5 (92-312) minutes. The time of ASCP was 145 (78-220) min. Intraoperative blood loss was 626.5 (300-3200) ml. Patients were extubated 8.9 (3.6-106.8) hours after surgery and held 3 (2-23) days in ICU. Conclusion. The proposed technology of aortic arch reconstruction is a radical, universal and individual method. It shows good clinical results without in-hospital mortality. This method allows for using the technique of “open distal anastomosis” simultaneously with normothermic cerebral perfusion. Keywords: aortic aneurysm; aortic dissection; total reconstruction of the aortic arch; selective antegrade cerebral perfusion; normothermic perfusionReceived 26 October 2016. Accepted 14 December 2016.Funding: The study had no sponsorship. Conflict of interest: The authors declare no conflict of interest. Author contributions Conceptualization and study design: Rosseykin E.V., Evdokimov M.E., Bazylev V.V. Material acquisition and analysis: Evdokimov M.E., Batrakov P.A., Gebgart T.V. Statistical data processing: Evdokimov M.E., Batrakov P.A., Kobzev E.E. Article writing: Evdokimov M.E., Batrakov P.A. Review & editing: Evdokimov M.E., Rosseykin E.V., Bazylev V.V.

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Totally normothermic aortic arch replacement without circulatory arrest

Cited by 22 publications

References 6 publications

Axillary artery cannulation in ascending aortic pathologies

Axillary artery cannulation in ascending aortic pathologies

Cirurgia do arco aórtico com perfusão cerebral bilateral pelo isolamento do tronco braquiocefálico e da artéria carótida esquerda

Change of paradigm in the aortic arch reconstruction – “warm head – cool body”

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