Varying Evidence on Deep Hypothermic Circulatory Arrest in Thoracic Aortic Aneurysm Surgery

Gupta, Prity; Harky, Amer; Jahangeer, Saleem; Adams, Benjamin; Bashir, Mohamad

doi:10.14503/thij-17-6364

Cited by 37 publications

(25 citation statements)

References 50 publications

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“…While known complications of DHCA are postischemic hypothermia, impaired autoregulatory mechanisms, and damage to the blood-brain barrier, 30 we found no significant association with postoperative SWI lesion count after adjusting for CPB time on multivariate analysis.…”

Section: Cardiopulmonary Bypasscontrasting

confidence: 82%

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

Breiding

Duerrenmatt

Meinel

et al. 2019

JAHA

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BackgroundIn patients with mechanical heart valves, cerebral susceptibility‐weighted imaging (SWI) lesions on magnetic resonance imaging, postulated to be caused by degenerative metallic abrasion, are frequently referred to as valve abrasion. It remains unclear whether valve implantation not requiring cardiopulmonary bypass or biological heart valves also shows those lesions.Methods and ResultsTwo blinded readers rated SWI lesions and cerebral amyloid angiopathy probability according to established criteria on brain magnetic resonance imaging pre‐ and postinterventionally. We assessed the association between valve type/cardiopulmonary bypass use and SWI lesion count on the first postinterventional scan using multivariable logistic regression. On postinterventional magnetic resonance imaging, 57/58 (98%) patients with mechanical heart valves had at least 1 and 46/58 (79%) 3 or more SWI lesions, while 92/97 (95%) patients with biological heart valves had at least 1 and 72/97 (74%) 3 or more SWI lesions. On multivariate analysis, duration of cardiopulmonary bypass during implantation significantly increased the odds of having SWI lesions on the first postinterventional magnetic resonance imaging (β per 10 minutes 0.498; 95% CI, 0.116–0.880; P=0.011), whereas valve type showed no significant association (P=0.338). Thirty‐seven of 155 (23.9%) patients fulfilled the criteria of possible/probable cerebral amyloid angiopathy.Conclusions SWI lesions in patients with artificial heart valves evolve around the time point of valve implantation and the majority of patients had multiple lesions. The missing association with the valve type weakens the hypothesis of degenerative metallic abrasion and highlights cardiopulmonary bypass as the main risk factor for SWI occurrence. SWI lesions associated with cardiac procedures can mimic cerebral amyloid angiopathy. Further research needs to clarify whether those lesions are associated with intracranial hemorrhage after intravenous thrombolysis or anticoagulation.

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Section: Cardiopulmonary Bypasscontrasting

confidence: 82%

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

Breiding

Duerrenmatt

Meinel

et al. 2019

JAHA

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“…Hypothermic circulatory arrest (HCA) is an effective procedure to perform open anastomosis in bloodless fields while protecting whole organs in aortic surgery [ 1 – 3 ]. It is well-known that hypothermia may cause coagulopathy, but it is difficult to prove in clinical practice [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

Ise

Kuwabara

Oyama

et al. 2020

Gen Thorac Cardiovasc Surg

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Objectives Hypothermic circulatory arrest (HCA) has been considered to cause coagulopathy during cardiac surgery. However, coagulopathy associated with HCA has not been understood clearly in details. The objective of this study is to analyze the details of coagulopathy related to HCA in cardiac surgery by using rotational thromboelastometry (ROTEM). Methods We retrospectively analyzed 38 patients who underwent elective cardiac surgery (HCA group = 12, non-HCA group = 26) in our hospital. Blood samples were collected before and after cardiopulmonary bypass (CPB). Standard laboratory tests (SLTs) and ROTEM were performed. We performed four ROTEM assays (EXTEM, INTEM, HEPTEM and FIBTEM) and analyzed the following ROTEM parameters: clotting time (CT), clot formation time (CFT), maximum clot firmness (MCF) and maximum clot elasticity (MCE). The amount of perioperative bleeding, intraoperative transfusion and perioperative data were compared between the HCA and non-HCA group. Results Operation time and hemostatic time were significantly longer in the HCA group, whereas CPB time had no difference between the groups. The amount of perioperative bleeding and intraoperative transfusion were much higher in the HCA group. SLTs showed no difference between the groups both after anesthesia induction and after protamine reversal. In ROTEM analysis, MCE contributed by platelet was reduced in the HCA group, whereas MCE contributed by fibrinogen had no difference. Conclusion Our study confirmed that the amount of perioperative bleeding and intraoperative transfusion were significantly higher in the HCA group. ROTEM analysis would indicate that clot firmness contributed by platelet component is reduced by HCA in cardiac surgery.

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“…IA cannulation also avoids the risks of a retrograde perfusion, such as cerebral emboli and malperfusion following femoral cannulation . A disadvantage of IA cannulation is that its use is limited to IA that is not diseased . The literature did not report the incidence of discovering a diseased IA in the preoperative work up or during the surgery which would make it unacceptable for cannulation.…”

Section: Resultsmentioning

confidence: 98%

Innominate artery cannulation in aortic surgery: A systematic review

et al. 2018

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Objective: The innominate artery is considered an alternative site for establishing cardiopulmonary bypass in surgical procedures involving the thoracic aorta. This systematic review examines the use of innominate artery cannulation in aortic surgery.Methods: A systematic literature search was undertaken among the four major databases (PubMed, Embase, Scopus, and Ovid) to identify all studies that utilized innominate artery cannulation for establishing cardiopulmonary bypass and providing cerebral perfusion in thoracic aortic surgery. The data were reviewed up to September 2018.Results: Acute type A aortic dissection contributed to 36% (n = 818) of the total 2,290 patients. 31.5% (n = 719) underwent surgery on the aortic root only; 54.5% (n = 1246) had ascending and hemi-arch replacement, while 11.5% had total aortic arch replacement and 2.5% had a frozen elephant trunk inserted. Postoperative stroke rate was 1.25% (n = 28), temporary neurological deficit was 4.8% (n = 111). All-cause 30-day mortality rate was 2.7% (n = 61).Conclusion: Innominate artery cannulation is a safe technique in patients who undergo thoracic aortic surgery. It can be utilized, in selected cases, as a reliable route for establishing cardiopulmonary bypass and maintaining cerebral perfusion. K E Y W O R D S aorta, aortic surgery, cannulation, innominate artery

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Varying Evidence on Deep Hypothermic Circulatory Arrest in Thoracic Aortic Aneurysm Surgery

Cited by 37 publications

References 50 publications

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

Prevalence and Evolution of Susceptibility‐Weighted Imaging Lesions in Patients With Artificial Heart Valves

Hypothermic circulatory arrest induced coagulopathy: rotational thromboelastometry analysis

Innominate artery cannulation in aortic surgery: A systematic review

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