Thromboelastography during thoracic aorta replacement with hypothermic circulatory arrest and antegrade selective cerebral perfusion

Although hypothermic circulatory arrest with antegrade selective cerebral perfusion is used for cerebral protection, optimal perfusion characteristics are still unclear. Between May 2006 and March 2008, 26 patients (mean age, 68.9 years; 14 males) underwent thoracic aortic repair with mild hypothermic circulatory arrest (34.3°C ±1.9°C) and antegrade selective cerebral perfusion (30°C) for various indications including 16 acute type A aortic dissections. Mean cerebral perfusion rate was 21.1 ± 4.3mL kg−1 min−1. Non-elective operations were carried out in 16 (61.5%) cases. Operative procedures were ascending aortic replacement in 16 patients, hemiarch replacement in 4, and total arch replacement in 6. Cardiopulmonary bypass time was 209 ± 61 min, cardiac ischemic time was 141 ± 45 min, cerebral perfusion time was 81 ± 67 min, and lower body circulatory arrest time was 65 ± 22 min. Mean rectal temperature drifted to 30.6°C ± 1.3°C. There was 1 (3.8%) hospital death due to rupture of a residual descending thoracic aneurysm. One patient needed reexploration for bleeding, and 2 (7.7%) suffered permanent neurologic dysfunction. No postoperative spinal cord dysfunction was observed. Mild hypothermic circulatory arrest with antegrade selective cerebral perfusion could be performed safely in our patient population.

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Predictors of Prolonged Mechanical Ventilation After Aortic Arch Surgery With Deep Hypothermic Circulatory Arrest Plus Antegrade Selective Cerebral Perfusion

Journal of Cardiothoracic and Vascular Anesthesia ◽

10.1053/j.jvca.2008.09.006 ◽

2009 ◽

Vol 23 (4) ◽

pp. 495-500 ◽

Cited By ~ 8

Author(s):

Qian Lei ◽

Lei Chen ◽

Yi Zhang ◽

Nengxin Fang ◽

Weiping Cheng ◽

...

Keyword(s):

Mechanical Ventilation ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Prolonged Mechanical Ventilation ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Selective Cerebral Perfusion ◽

Aortic Arch Surgery ◽

Antegrade Selective Cerebral Perfusion

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Total aortic arch replacement using hypothermic circulatory arrest with antegrade selective cerebral perfusion: are there cerebral deficits other than frank stroke?

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-012-0057-8 ◽

2012 ◽

Vol 60 (6) ◽

pp. 345-349 ◽

Cited By ~ 4

Author(s):

Kotaro Hiraoka ◽

Satoshi Kawatsu ◽

Etsuro Mori ◽

Yoshikatsu Saiki

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Selective Cerebral Perfusion ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Antegrade Selective Cerebral Perfusion

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Cerebral Metabolic Profiling of Hypothermic Circulatory Arrest with and Without Antegrade Selective Cerebral Perfusion

Chinese Medical Journal ◽

10.4103/0366-6999.178012 ◽

2016 ◽

Vol 129 (6) ◽

pp. 702-708 ◽

Cited By ~ 1

Author(s):

Li-Hua Zou ◽

Jin-Ping Liu ◽

Hao Zhang ◽

Shu-Bin Wu ◽

Bing-Yang Ji

Keyword(s):

Metabolic Profiling ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Selective Cerebral Perfusion ◽

Antegrade Selective Cerebral Perfusion

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Thoracic Aortic Aneurysms in Octogenarians: The Results of Open Surgical Repair Using Hypothermic Circulatory Arrest with Antegrade Selective Cerebral Perfusion

Journal of Nippon Medical School ◽

10.1272/jnms.81.12 ◽

2014 ◽

Vol 81 (1) ◽

pp. 12-18

Author(s):

Ryuzo Bessho ◽

Y^|^ocirc;suke Ishii ◽

Dai Nishina ◽

Yasuhiro Kawase

Keyword(s):

Cerebral Perfusion ◽

Surgical Repair ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Aortic Aneurysms ◽

Selective Cerebral Perfusion ◽

Open Surgical Repair ◽

Thoracic Aortic Aneurysms ◽

Antegrade Selective Cerebral Perfusion

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Performing Antegrade Selective Cerebral Perfusion Using the AV Cannula: A Novel Approach

Aorta ◽

10.1055/s-0039-3401997 ◽

2019 ◽

Vol 07 (06) ◽

pp. 181-184

Author(s):

Andrea Venturini ◽

Alan Gallingani ◽

Angiolino Asta ◽

Chiara Zanchettin ◽

Giampaolo Zoffoli ◽

...

Keyword(s):

Surgical Technique ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Selective Cerebral Perfusion ◽

Brain Protection ◽

Novel Approach ◽

New Type ◽

Antegrade Selective Cerebral Perfusion

AbstractAntegrade selective cerebral perfusion has become the preferred choice for brain protection during aortic arch surgery. To perform antegrade selective cerebral perfusion, cannulas have been introduced directly into the ostia of the supra-aortic vessels (SAV) after institution of hypothermic circulatory arrest and opening the aortic arch. We describe a different surgical technique with a new type of cannula for antegrade selective cerebral perfusion. This cannula, called AV (Andrea Venturini) cannula, has been designed to be introduced in the SAV directly using a standard guidewire technique (Seldinger's technique). The AV cannula can also be introduced from the ostia of the SAV if preferred. The AV cannula can be introduced before the institution of hypothermic circulatory arrest and before opening the aortic arch. One great advantage of this technique is that the ostia of the SAV remain free from a cannula, allowing the operator easier access and a faster anastomosis or reimplantation.

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