Antegrade cerebral perfusion with mild hypothermia (28-30°C) provides save visceral organ protection during aortic arch replacement

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
A Zierer ◽  
F Detho ◽  
M Doss ◽  
S Martens ◽  
A Moritz
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Mild Hypothermia ◽  
Visceral Organ ◽  
Organ Protection ◽  
Aortic Arch Replacement ◽  
Antegrade Cerebral Perfusion

Complete aortic arch replacement using cerebral perfusion and mild hypothermia

2012 ◽  
Vol 60 (S 01) ◽  
Author(s):  
PP Urbanski ◽  
M Raad ◽  
A Lenos ◽  
P Bougioukakis ◽  
A Diegeler
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Mild Hypothermia ◽  
Aortic Arch Replacement

scholarly journals Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience

Aorta ◽  
2021 ◽  
Author(s):  
Petar Risteski ◽  
Isabel Radacki ◽  
Andreas Zierer ◽  
Aris Lenos ◽  
Anton Moritz ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Operative Mortality ◽  
Mild Hypothermia ◽  
Aortic Surgery ◽  
Graft Infection ◽  
Elephant Trunk ◽  
Aortic Arch Surgery ◽  
Systemic Hypothermia ◽  
Antegrade Cerebral Perfusion

Abstract Background The aim of the study was to assess the indications, surgical strategies, and outcomes after reoperative aortic arch surgery performed generally under mild hypothermia. Methods Ninety consecutive patients (60 males, mean age, 55 ± 16 years) underwent open reoperative aortic arch surgery after previous cardiac aortic surgery. The indications included chronic-progressive arch aneurysm (55.5%), chronic aortic dissection (17.8%), contained arch rupture (16.7%), and graft infection (10%). The reoperation was performed through a repeat sternotomy (96%) or clamshell thoracotomy (4%) using antegrade cerebral perfusion under mild systemic hypothermia (28.9 ± 2.5°C) in all except three patients. Results The surgery comprised hemiarch or total arch replacement in 41 (46%) and 49 (54%) patients, respectively. The distal extension included classic or frozen elephant trunk technique, each in 12 patients, and total descending aorta replacement in 4 patients. Operative mortality was 6 (6.7%) among all patients, with age identified as the only independent predictor of operative mortality (p = 0.05). Permanent and transient neurologic deficits occurred in 1% and 9% of the patients, respectively. Estimated survival at 8 years was 59 ± 8% with advanced heart failure predictive for late mortality (p = 0.014). Freedom from second reoperation or intervention on the aorta was 78 ± 6% at 8 years, with most of these events occurring downstream in patients with chronic degenerative aneurysms. Conclusion Aortic arch reoperations performed using antegrade cerebral perfusion under mild systemic hypothermia offer favorable operative outcomes with an exceptionally low rate of neurologic morbidity without any difference between hemiarch and complex arch procedures.

scholarly journals Cerebral and visceral organ protection during aortic arch surgery. Intraoperative tactics and monitoring details

2016 ◽  
Vol 20 (4) ◽  
pp. 34 ◽  
Author(s):  
Yu. V. Belov ◽  
E. R. Charchyan ◽  
B. A. Akselyrod ◽  
D. A. Gusykov ◽  
S. V. Fedulova ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Core Temperature ◽  
Conflict Of Interest ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Organ Protection ◽  
Aortic Arch Surgery ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Antegrade Cerebral Perfusion

<p><strong>Aim.</strong> The study is aimed at presenting the protocol of intraoperative organ protection, analyzing its effectiveness during aortic arch surgery and evaluating the rate of postoperative complications in this group of patients. <br /><strong>Methods.</strong> The study included 141 patients. In the first group (n=70) patients underwent aortic arch surgery with hypothermic circulatory arrest (target core temperature 26 °C) and antegrade cerebral perfusion. Patients of the second group (n=71) underwent ascending aortic replacement using cardiopulmonary bypass with moderate hypothermia (target core temperature 32 °C). Cerebral and tissue oxygenation monitoring was performed in all the cases. In the first group transcranial Doppler monitoring was also performed. 33 patients in the first group and 34 patients in the second group underwent testing before and after surgery in order to evaluate cognitive function. Patients’ condition was evaluated during the in-hospital period that was about 15.97±20.54 days. <br /><strong>Results.</strong> In-hospital mortality rate was 4,2 % in the first group and 0% in the second one (p=0.12). Stroke was observed in 1.4 and 0 % of cases respectively. The rate of encephalopathy (as the leading symptom) was 7.1 and 5.6 % in 1st and 2nd groups respectively. Multimodal monitoring enabled to dynamically adjust the flow rate of antegrade cerebral perfusion. As a result, cerebral SctO2 and linear velocity were maintained within the acceptable range.<br /><strong>Conclusion.</strong> The presented protocol proved to be effective, it allows to perform aortic arch surgery with the same postoperative neurological complications’ rate as after ascending aortic replacement. We recommend performing reconstructive aortic arch surgery by using moderate hypothermic circulatory arrest (26-28 °С) and selective antegrade cerebral perfusion. In this modality, it is important to perform the distal anastomosis quickly and start patient’s rewarming (this will significantly shorten the duration of cardiopulmonary bypass and, as a result, decrease the rate of postoperative complications) and to carry out both precise intraoperative monitoring of the brain condition (by using cerebral oxymetry and transcranial Doppler) and central core temperature.</p><p>Received 21 June 2016. Accepted 21 October 2016.</p><p><strong>Funding:</strong> The study had no sponsorship.<br /><strong>Conflict of interest:</strong> The authors declare no conflict of interest.<br /><strong>Author contributions</strong><br />Conceptualization and study design: Belov Yu.V., Charchyan E.R., Akselrod B.A.<br />Material acquisition and analysis: Khachatryan Z.R., Oystrakh A.S., Medvedeva L.A., Guskov D.A., Fedulova S.V.<br />Statistical data processing: Khachatryan Z.R., Guskov D.A., Skvortsov A.A.<br />Article writing: Akselrod B.A., Khachatryan Z.R., Skvortsov A.A. <br />Review &amp; editing: Charchyan E.R., Akselrod B.A., Eremenko A.A., Belov Yu.V.</p>

scholarly journals Total Aortic Arch Replacement: Indications and Technical Considerations of Surgical Management

2020 ◽  
pp. 79-87
Author(s):  
L. Kulyk ◽  
I. Protsyk ◽  
D. Beshley ◽  
A. Schnaidruk ◽  
V. Petsentii ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Deep Hypothermia ◽  
Arterial Cannulation ◽  
Descending Thoracic Aorta ◽  
Aortic Arch Replacement ◽  
Descending Aorta ◽  
Total Aortic Arch Replacement ◽  
The Brain ◽  
Antegrade Cerebral Perfusion

The total aortic arch replacement is one of the most technically demanding operations, the main risk of which is the intraoperative ischemic lesion of the brain. Despite progress, operating mortality associated with this operation, even at the most renowned specialized centers reaches 7.3%. An alternative to the classic “open” operation is aortic endoprosthesis, combined with the procedure of debranching. This approach allows diminishing trauma by reducing the duration of the cardiopulmonary bypass. The aim. To describe the rational approach for replacing the total aortic arch depending on the diameter of aneurysm, the condition of the arch vessels, and the acuteness of clinical condition.The main indications for the replacement of the aortic arch are the true atherosclerotic aneurysms, genetic connective tissue diseases (Marfan syndrome), syphilis. The total arch replacement recently becomes more frequent indication for acute type A aortic dissection. The newly introduced strategies of operation and perfusion for total aortic arch replacement are aimed to reduce the risk of neurological complications. This method is named “arch first technique” which gradually replaces the earlier technique, at which the first anastomosis is performed with a descending thoracic aorta. A more traditional method called the “descending aorta first” was selected. A mandatory element of both types of the operation is antegrade cerebral perfusion. The main advantage of this method is maintaining constant perfusion of the brain which significantly reduces the risk of its ischemic damage, avoids deep hypothermia and its negative impact on blood coagulation system. The technique of total arch replacement consists of the following elements: access, double arterial cannulation, the method of brain protection, formation of distal anastomosis with descending thoracic aorta, implantation of arch vessels into the prosthesis. Sequence of anastomosis depends on morphological and clinical peculiarities of the specific case. Changes in the strategy for “open” total aortic arch replacement in various aortic pathologies is discussed based on the author’s clinical experience and literature data. Conclusions. Total aortic arch replacement remains a traumatic and technically demanding operation, the main risks of which are hemorrhage and ischemic brain lesions. The method of arch replacement – “descending aorta first” includes double arterial cannulation, antegrade cerebral perfusion, deep hypothermia with complete blood flow stoppage for the lower half of the body and the use of multi-branch vascular prosthesis.

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