Use of Hypothermia and Cardiopulmonary Bypass in Resection of Aortic Arch Aneurysms

Philips, Peter A.; Miyamoto, Alfonso M.

doi:10.1016/s0003-4975(10)65669-x

Cited by 12 publications

(4 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Lesions which involve the ascending aorta and the transverse arch present the surgeon and perfusionist with the formidable challenge of cerebral preservation during interrupted flow. Early experience in treating these patients included cannulation of the brachiocephalic vessels, while systemic extracorporeal circulation (ECC) was either reduced or altogether stopped (1)(2)(3)(4). As the clinical use of hypothermia and its physiochemical characteristics became better established in thoracic surgery, several individuals examined these effects on the protection of the central nervous system during a period of circulatory arrest (5)(6)(7)(8)(9)(10).…”

mentioning

confidence: 99%

“…Several investigators have questioned the use of cerebral perfusion because of the complexity involved in circuit design (3,6,13,15). The various results obtained by utilizing brachiocephalic perfusion may reflect the lack of consensus on appropriate cerebral flows and pressures during ECC (1)(2)(3)(4)(11)(12)(13)(14)(15). The benefits of brachiocephalic perfusion during surgical repair of these arch lesions include; one, a continuous supply of nutritive oxygenated perfusate provided to the still metabolically active tissue, two, reduction in the level of systemic hypothermia which may limit postoperative coagulopathies, and three, time extension for surgical repair.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Extracorporeal Circulation During Treatment of Aneurysms of the Ascending Aorta

Stammers,

Butler,

Kirsh

1990

J Extra Corpor Technol

View full text Add to dashboard Cite

Extracorporeal circulation in the treatment of aneurysms of the ascending aorta and transverse arch present both the surgeon and perfusionist with a formidable challenge. Thirty-one patients presented with either of these anomalies and have been treated in a two-year period from August 1987 to December 1989 at the University of Michigan. Of these, 11 had lesions which involved one or more arch vessels and necessitated either a period of circulatory arrest (7 patients) or brachiocephalic perfusion (four patients). Mean circulatory arrest periods were 44.8 ± 9.0 minutes (Mean ± SD), while the brachiocephalic perfusion patients had one or more arch vessels cannulated for a mean length of 64.3 ± 19.7 minutes. Postoperative complications in both groups included pulmonary and renal insufficiency, coagulopathies, and neurological deficits. The circulatory arrest group experienced encephalopathies (5/7 patients) and high perioperative mortality (4/7 patients). In the brachiocephalic perfusion group only one patient experienced postoperative neurological complications and there were no immediate postoperative deaths. Lesions of the ascending and transverse aorta are often associated with high morbidity and mortality. Although these population groups are small we believe that the technique of cerebral perfusion via cannulation of the brachiocephalic vessels provides a safe alternative to that of hypothermic circulatory arrest.

show abstract

mentioning

confidence: 99%

mentioning

confidence: 99%

Extracorporeal Circulation During Treatment of Aneurysms of the Ascending Aorta

Stammers,

Butler,

Kirsh

1990

J Extra Corpor Technol

View full text Add to dashboard Cite

show abstract

“…The entire arch was replaced with a homograft utilizing cardiopulmonary bypass with selective brachiocephalic and left carotid perfusion via separate pump heads at high flow rates. With this modification the cerebral blood flow was determined by cerebral vascular resistance and the conduction of bypass was greatly simplified [16,17]. The high flow rates, initially utilized for cerebral perfusion, were reduced in favor of lower pressures and flow rates because of the high incidence of central nervous system damage incurred with the former technique [2].…”

mentioning

confidence: 99%

“…Further modification included the elimination of separate pumps and the addition of regulated moderate hypothermia. With this modification the cerebral blood flow was determined by cerebral vascular resistance and the conduction of bypass was greatly simplified [16,17]. Myocardial protection was provided by separate coronary perfusion [18] or, more recently, by topical hypothermia [19,20] or cardioplegia [21].…”

mentioning

confidence: 99%

Progress in treatment of aneurysms of the aortic arch

1980

World j. surg.

View full text Add to dashboard Cite

A review of past and current operative procedures for treatment of aneurysms of the aortic arch is presented in conjunction with a series of 14 patients in whom the aortic arch and variable portions of the ascending and descending aorta were replaced utilizing a combination of surface cooling and cardiopulmonary bypass to produce profound total body hypothermia. Arch replacement was carried out during a single period of circulatory arrest. Cardiopulmonary bypass was then utilized to warm the patient and resuscitate the heart. The average cerebral ischemia time was 42 minutes at an average core temperature of 14°C. The average myocardial ischemia time was 68 minutes, and the average duration of cardiopulmonary bypass was 122 minutes. There were 4 deaths in this series. Of the I0 patients undergoing elective operation only 1 died. The remaining patients are alive and well 4 months to 6 years following surgery. This experience indicates that by utilizing total body hypothermia and circulatory arrest, aortic arch replacement can be carried out with superior results. This technique is our method of choice and should find increasing application.

show abstract

Reconstruction of the Aortic Arch for Aneurysm

Ergin¹,

Griepp²

1986

International Practice in Cardiothoracic Surgery

View full text Add to dashboard Cite

Use of Hypothermia and Cardiopulmonary Bypass in Resection of Aortic Arch Aneurysms

Cited by 12 publications

References 6 publications

Extracorporeal Circulation During Treatment of Aneurysms of the Ascending Aorta

Extracorporeal Circulation During Treatment of Aneurysms of the Ascending Aorta

Progress in treatment of aneurysms of the aortic arch

Reconstruction of the Aortic Arch for Aneurysm

Contact Info

Product

Resources

About