scholarly journals Results of Proximal Arch Replacement Using Deep Hypothermia for Circulatory Arrest: Is Moderate Hypothermia Really Justifiable?

2011 ◽  
Vol 77 (11) ◽  
pp. 1438-1444 ◽  
Author(s):  
Brian Lima ◽  
Judson B. Williams ◽  
S. Dave Bhattacharya ◽  
Asad A. Shah ◽  
Nicholas Andersen ◽  
...  
Keyword(s):  
Renal Failure ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Deep Hypothermia ◽  
Aortic Root Replacement ◽  
Moderate Hypothermia ◽  
Selective Cerebral Perfusion ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement

The use of selective cerebral perfusion with warmer temperatures during circulatory arrest has been increasingly used for arch replacement over concerns regarding the safety of deep hypothermic circulatory arrest (DHCA). However, little data actually exist on outcomes after arch replacement and DHCA. This study examines modern results with DHCA for proximal arch replacement to provide a benchmark for comparison against outcomes with lesser degrees of hypothermia. Between July 2005 and June 2010, 245 proximal arch replacements (“hemiarch”) were performed using deep hypothermia; mean minimum core and nasopharyngeal temperatures were 18.0 ± 2.1°C and 14.1 ± 1.6°C, respectively. Adjunctive cerebral perfusion was used in all cases. Concomitant ascending aortic replacement was performed in 41 per cent, ascending plus aortic valve replacement in 23 per cent, and aortic root replacement in 32 per cent. Mean age was 58 ± 14 years; 36 per cent procedures were urgent/emergent. Mean duration of DHCA was 20.4 ± 6.2 minutes. Thirty-day/in-hospital mortality was 2.9 per cent. Rates of stroke, renal failure, and respiratory failure were 4.1 per cent (0.8% for elective cases), 1.2 per cent, and 0.4 per cent, respectively. Deep hypothermia with adjunctive cerebral perfusion for circulatory arrest during proximal arch replacement affords excellent neurologic as well as nonneurologic outcomes. Centers using lesser degrees of hypothermia for arch surgery, the safety of which remains unproven, should ensure comparable results.

Acid-base Management in Cardiopulmonary Bypass

2021 ◽  
Vol 13 (2) ◽  
pp. 134-143
Author(s):  
Sonny Lesmana Surya ◽  
Yudi Hadinata
Keyword(s):  
Cardiopulmonary Bypass ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Selective Cerebral Perfusion ◽  
Acid Base ◽  
Cerebral Dysfunction ◽  
Base Management ◽  
Ph Stat

Cardiopulmonary bypass (CPB) merupakan alat penunjang fungsi sirkulasi dan pernapasan pasien yang biasa digunakan ketika menjalani pembedahan jantung atau pembuluh darah besar. Selama prosedur CPB, kondisi hipotermia dipertahankan untuk menurunkan kebutuhan oksigen dan laju metabolisme. Kondisi hipotermia akan mempengaruhi keseimbangan asam-basa pada tubuh. Manajemen asam-basa selama prosedur CPB dicapai dengan menggunakan metode a-stat atau pH-stat. Pada metode a-stat, manajemen asam-basa dilakukan dengan menjaga pHa 7.4 dan PaCO2 40 mmHg pada suhu 37oC tanpa penambahan CO2 oksigen untuk menjaga total CO2 tetap konstan. Sedangkan, pada metode pH-stat, diberikan CO2 oksigen untuk menjaga PaCO2 40 mmHg dan pHa 7.4 secara in vivo. Masih banyak perdebatan terkait waktu penerapan masing-masing metode. Pada level mikrosirkulasi, manajemen a-stat terbukti memberikan keuntungan pada otak dan mengurangi insidensi postoperative cerebral dysfunction. Sedangkan, metode pH-stat dilaporkan meningkatkan risiko emboli otak, sehingga tidak disarankan untuk pasien yang memiliki risiko tinggi gangguan aliran darah otak. Namun, terdapat pula laporan yang menyatakan pH-stat bermanfaat pada operasi bedah jantung anak. Berdasarkan hal itu, usia pasien dapat menentukan waktu penggunaan metode a-stat dan pH-stat. Satu indikasi primer penggunaan pH-stat adalah selama proses pendinginan saat deep hypothermic circulatory arrest (DHCA), sedangkan metode a-stat lebih baik digunakan selama selective cerebral perfusion (SCP) dan rewarming.

Safety of Mild Hypothermic Circulatory Arrest with Selective Cerebral Perfusion

2009 ◽  
Vol 17 (5) ◽  
pp. 500-504 ◽  
Author(s):  
Masashi Toyama ◽  
Yasumoto Matsumura ◽  
Akinori Tamenishi ◽  
Hiroshi Okamoto
Keyword(s):  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Hospital Death ◽  
Acute Type ◽  
Selective Cerebral Perfusion ◽  
Ischemic Time ◽  
Aortic Replacement ◽  
Spinal Cord Dysfunction ◽  
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.

scholarly journals Large Intramural Aortic Hematoma with Intimal Tear

Aorta ◽  
2020 ◽  
Vol 08 (04) ◽  
pp. 118-120
Author(s):  
Frédéric Jacques ◽  
Michel Gingras ◽  
Valérie Lafrenière-Bessi ◽  
Jean Perron ◽  
François Dagenais
Keyword(s):  
Epigastric Pain ◽  
Circulatory Arrest ◽  
Intramural Hematoma ◽  
Filling Defect ◽  
Deep Hypothermic Circulatory Arrest ◽  
Ascending Aorta ◽  
Chest Computed Tomography ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
Aortic Intramural Hematoma

AbstractA 72-year-old man presented with excruciating epigastric pain. A chest computed tomography angiography revealed an aortic intramural hematoma. A filling defect within the distal ascending aorta was noted. Images of an intramular hematoma and surgical details of an ascending aortic replacement under deep hypothermic circulatory arrest are provided.

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>

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