Aortic arch repair under moderate hypothermic circulatory arrest with or without antegrade cerebral perfusion based on the extent of repair

A 46 years female underwent aortic arch repair surgery under deep hypothermic circulatory arrest (DHCA) and right antegrade cerebral perfusion. The patient was extubnated after 13 hours of the surgery and discharged from SICU on third post operative day and discharged from hospital on sixth postoperative day uneventfully and with excellent neurological functions. It was the first case of aortic arch repair in our hospital. Combination of DHCA and right antegrade cerebral perfusion may be the reason for better neurological outcome.

Download Full-text

Impact of brain protection strategies on mortality and stroke in patients undergoing aortic arch repair with hypothermic circulatory arrest: evidence from the Canadian Thoracic Aortic Collaborative

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa023 ◽

2020 ◽

Vol 58 (1) ◽

pp. 95-103 ◽

Cited By ~ 1

Author(s):

Ali Hage ◽

Louis-Mathieu Stevens ◽

Maral Ouzounian ◽

Jennifer Chung ◽

Ismail El-Hamamsy ◽

...

Keyword(s):

Propensity Score ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Multivariable Analysis ◽

Hypothermic Circulatory Arrest ◽

Deep Sternal Wound Infection ◽

Aortic Arch Repair ◽

The Impact ◽

Antegrade Cerebral Perfusion

Abstract OBJECTIVES The aim of this study was to investigate the impact of various brain perfusion techniques and nadir temperature cooling strategies on outcomes after aortic arch repair in a contemporary, multicentre cohort. METHODS A total of 2520 patients underwent aortic arch repair with hypothermic circulatory arrest (HCA) between 2002 and 2018 in 11 centres of the Canadian Thoracic Aortic Collaborative. Primary outcomes included mortality; stroke; a composite of mortality or stroke; and a Society of Thoracic Surgeons-defined composite (STS-COMP) end point for mortality or major morbidity including stroke, reoperation, renal failure, prolonged ventilation and deep sternal wound infection. Multivariable logistic regression and propensity score matching were performed for cerebral perfusion and nadir temperature practices. RESULTS Antegrade cerebral perfusion was found on multivariable analysis to be protective against mortality [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.48–0.86; P = 0.005], stroke (OR 0.55, 95% CI 0.37–0.81; P = 0.006), composite of mortality or stroke (OR 0.57, 95% CI 0.45–0.72; P = 0.0001) and STS-COMP (OR 0.53, 95% CI 0.41–0.67; P < 0.0001), as compared to HCA alone. Retrograde cerebral perfusion yielded similar outcomes as compared to antegrade cerebral perfusion. When compared to HCA with nadir temperature <24°C, a propensity score analysis of 647 matched pairs identified nadir temperature ≥24°C as predictor of lower mortality (OR 0.62, 95% CI 0.40–0.98; P = 0.04), stroke (OR 0.51, 95% CI 0.31–0.84; P = 0.008), composite of mortality or stroke (OR 0.62, 95% CI 0.43–0.89; P = 0.01) and STS-COMP (OR 0.64, 95% CI 0.49–0.85; P = 0.002). CONCLUSIONS Antegrade cerebral perfusion and nadir temperature ≥24°C during HCA for aortic arch repair are predictors of improved survival and neurological outcomes.

Download Full-text

Aortic arch repair — Report of experiences with deep hypothermic circulatory arrest and with retrograde cerebral perfusion

The AustralAsian Journal of Cardiac and Thoracic Surgery ◽

10.1016/1037-2091(92)90010-n ◽

1992 ◽

Vol 1 (2) ◽

pp. 31-36

Author(s):

George Matalanis ◽

Brian Buxton

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Retrograde Cerebral Perfusion ◽

Aortic Arch Repair

Download Full-text

Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i3.65 ◽

2019 ◽

Vol 1 (3) ◽

pp. 99-104

Author(s):

Mohamed Abdel Fouly

Keyword(s):

Cerebral Infarction ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Aortic Arch Surgery ◽

Significant Difference ◽

Arch Reconstruction ◽

Antegrade Cerebral Perfusion

Background: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

Download Full-text