The blood protective effect of autologous platelet separation in aortic dissection

2020 ◽  
Vol 76 (3) ◽  
pp. 361-366
Author(s):  
Li Zhao ◽  
Hao Wang ◽  
Shan-Shan Li ◽  
Feng Xin ◽  
Qi Wu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Protective Effect ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Perioperative Period ◽  
Deep Hypothermic Circulatory Arrest ◽  
Smoking History ◽  
Control Group ◽  
Elephant Trunk ◽  
Autologous Platelet

OBJECTIVE: This study aimed to retrospectively analyze the blood protective effect of autologous platelet separation in operations for acute aortic dissection. METHODS: A total of 130 patients with acute aortic dissection were enrolled into the present study. The average age of these patients was 52.962±10.5061 years old. These patients underwent the modified aortic arch replacement with the elephant trunk technique or endovascular aortic exclusion with covered stent. Among these patients, 68 patients who underwent autologous platelet separation were assigned to the platelet separation group, while the remaining patients were assigned to the control group. All operations were performed under deep hypothermic circulatory arrest. After anesthesia, 1–2 therapeutic doses of autologous platelets were isolated from patients in the platelet separation group, and these platelets were quickly infused back to these patients after heparin was neutralized by protamine at the end of the cardiopulmonary bypass. The preoperative and postoperative indexes in these two groups were compared. RESULTS: There were no statistically significant differences in age, gender, smoking history, drinking history and hypertension history between these two groups. Compared with controls, the transfusion volume of allogeneic platelets in the perioperative period significantly decreased in the platelet separation group (1.919±1.6226 vs. 0.794±1.1789, P < #x003C;< #x200A;0.05), and the use rate of allogeneic platelets also significantly decreased (74.19% vs. 45.59%, P < #x003C;< #x200A;0.05). CONCLUSION: The intraoperative auto transfusion of platelets significantly reduced the volume of allogeneic platelet transfusion after the operation for aortic dissection, which has a significant blood protective effect.

scholarly journals Concomitant Reconstruction of Arch Vessels during Repair of Aortic Dissection

2014 ◽  
Vol 41 (4) ◽  
pp. 421-424
Author(s):  
Slobodan Micovic ◽  
Dusko Nezic ◽  
Petar Vukovic ◽  
Marko Jovanovic ◽  
Branko Lozuk ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Upper Extremity ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Disease Process ◽  
Deep Hypothermic Circulatory Arrest ◽  
Brachiocephalic Artery ◽  
Complete Replacement ◽  
Cerebral Malperfusion

Surgery for acute aortic dissection is challenging, especially in cases of cerebral malperfusion. Should we perform only the aortic repair, or should we also reconstruct the arch vessels when they are severely affected by the disease process? Here we present a case of acute aortic dissection with multiple tears that involved the brachiocephalic artery and caused cerebral and right upper-extremity malperfusion. The patient successfully underwent complete replacement of the brachiocephalic artery and the aortic arch during deep hypothermic circulatory arrest, with antegrade cerebral protection. We have found this technique to be safe and reproducible for use in this group of patients.

scholarly journals Four-branched graft inversion technique for the distal anastomosis in acute aortic dissection

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu Zou ◽  
Peng Teng ◽  
Liang Ma
Keyword(s):  
Cardiac Arrest ◽  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Distal Anastomosis ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Inversion Technique ◽  
Elephant Trunk Procedure ◽  
Branched Graft

Abstract Background Distal anastomosis bleeding is an issue during total arch replacement with the frozen elephant trunk technique. We used the 4-branched graft inversion technique for the distal anastomosis in acute aortic dissection. The aim was to evaluate the feasibility and benefits of the technique used during the frozen elephant trunk procedure for acute aortic dissection. Methods From January 2017 to July 2019, 109 patients underwent total arch replacement for type A acute aortic dissections. Patients were divided according to the technique used for the distal anastomosis as follows: group G (n = 57; 4-branched graft inversion technique) and group C (n = 52; conventional method with Teflon felt). The postoperative variables were analysed. Results The hospital mortality rate was 9.2% (10/109). The mean cardiopulmonary bypass, cardiac arrest, and circulatory arrest times were 234.95 ± 71.88 min, 168.25 ± 61.33 min, and 39.19 ± 9.45 min, respectively. The circulatory arrest and cardiac arrest times were shorter in the graft inversion group than in the conventional group (36.46 ± 7.88 min vs. 42.19 ± 10.17 min, P = 0.001 and 156.21 ± 55.99 min vs. 181.44 ± 64.68 min, P = 0.031, respectively). There were 7 cases of stroke (6.4%) and 5 cases of paraplegia (4.6%). Additionally, 13 patients (11.9%) required temporary continuous renal replacement therapy. Respiratory failure occurred in 19 patients (17.4%). There were no significant differences in postoperative complications between the two groups. Conclusions The 4-branched graft inversion technique provides effective and confirmed haemostasis during total aortic arch replacement using the frozen elephant trunk procedure.

Antegrade versus Retrograde Cerebral Protection in Repair of Acute Ascending Aortic Dissection

2012 ◽  
Vol 78 (3) ◽  
pp. 349-351 ◽  
Author(s):  
Matthew L. Williams ◽  
Brian L. Ganzel ◽  
A. David Slater ◽  
Mark S. Slaughter ◽  
Jaimin R. Trivedi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Cerebral Protection ◽  
Cerebral Oximetry ◽  
Retrograde Cerebral Perfusion ◽  
P Values ◽  
Neurologic Outcomes ◽  
Cent Change

The objective of this study was to compare retrograde with antegrade cerebral protection during acute aortic dissection repair using cerebral oximetry measurements. Fifty consecutive acute ascending aortic dissection repairs were analyzed. Cerebral oximetry data were collected for 41 of 50. Eight patients who had antegrade cerebral protection alone and 29 of 41 had retrograde cerebral protection alone. The per cent change in cerebral oximetry values during deep hypothermic circulatory arrest from baseline and from prearrest values was compared for the two groups using Student t test. The per cent change from baseline for the antegrade patients was: right 13.8 per cent and left -2.5 per cent; the per cent change from baseline for retrograde patients was: right 0.8 per cent and left 0.2 per cent ( P values 0.216 and 0.725, respectively). The per cent change from the prearrest value for the antegrade patients was: right -12 per cent and left -15 per cent; the per cent change from prearrest for retrograde patients was: right -15 per cent and left -16 per cent ( P values 0.514 and 0.956, respectively). No compelling evidence for an advantage to either antegrade or retrograde cerebral perfusion was detected. Further study with a focus on neurologic outcomes is warranted.

EP17 IMPACT OF A MODIFIED INTRAOPERATIVE SETTING FOR THE MANAGEMENT OF CIRCULATORY ARREST IN TYPE A ACUTE AORTIC DISSECTION

2018 ◽  
Vol 19 ◽  
pp. e48
Author(s):  
I. Vendramin ◽  
D. Piani ◽  
A. Lechiancole ◽  
V. Ferrara ◽  
M. Meneguzzi ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A

Intraoperative angiography for visceral arteries originating from false lumen

2021 ◽  
pp. 021849232110414
Author(s):  
Shintaro Takago ◽  
Satoru Nishida ◽  
Yukihiro Noda ◽  
Yu Nosaka ◽  
Ryo Yamamura ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
False Lumen ◽  
External Iliac Artery ◽  
Acute Type ◽  
Elephant Trunk ◽  
Intraoperative Angiography ◽  
Visceral Arteries ◽  
Enhanced Computed Tomography

A 70-year-old man had an acute type B aortic dissection 9 years before his admission. The last enhanced computed tomography that was performed revealed an aneurysm that extended from the ascending aorta to the aortic arch, associated with a chronic aortic dissection, which extended from the aortic arch to the left external iliac artery. His visceral arteries originated from the false lumen. We performed a total arch replacement with a frozen elephant trunk in the hybrid operating room. Immediately after the circulatory arrest termination, using intraoperative angiography, we verified that the blood supply to the visceral arteries was patent.

scholarly journals Complete Shrinkage of the Obliterated False Lumen After Open and Endovascular Chronic Aortic Dissection Stanford Type A Repair

Aorta ◽  
2017 ◽  
Vol 05 (02) ◽  
pp. 61-63
Author(s):  
George Samanidis ◽  
Meletios Kanakis ◽  
Constantinos Ieromonachos ◽  
George Stavridis
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
False Lumen ◽  
Type A ◽  
Frozen Elephant Trunk ◽  
Descending Thoracic Aorta ◽  
Elephant Trunk ◽  
Chronic Aortic Dissection ◽  
Antegrade Cerebral Perfusion

AbstractA 48-year-old man was admitted to our hospital with chronic aortic dissection Stanford Type A. His diagnosis was confirmed by chest multi-detector computed tomography (CT). The patient underwent combined (i.e., hybrid) open and endovascular repair (frozen elephant trunk) in a one-stage operation with moderate hypothermic circulatory arrest and antegrade cerebral perfusion. His postoperative course was uneventful, and he was discharged home on postoperative day 9. At 2-year follow-up, chest CT angiography revealed complete shrinkage of the obliterated false lumen in the distal aortic arch and descending thoracic aorta.

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