scholarly journals The Role of Deep Hypothermia in Cardiac Surgery

2021 ◽  
Vol 18 (13) ◽  
pp. 7061
Author(s):  
Radosław Gocoł ◽  
Damian Hudziak ◽  
Jarosław Bis ◽  
Konrad Mendrala ◽  
Łukasz Morkisz ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Arch ◽  
Cerebral Oxygenation ◽  
Circulatory Arrest ◽  
Deep Hypothermia ◽  
Body Core Temperature ◽  
Congenital Defects ◽  
Acute Type ◽  
Organ Protection ◽  
Blood Temperature

Hypothermia is defined as a decrease in body core temperature to below 35°C. In cardiac surgery, four stages of hypothermia are distinguished: mild, moderate, deep, and profound. The organ protection offered by deep hypothermia (DH) enables safe circulatory arrest as a prerequisite to carrying out cardiac surgical intervention. In adult cardiac surgery, DH is mainly used in aortic arch surgery, surgical treatment of pulmonary embolism, and acute type-A aortic dissection interventions. In surgery treating congenital defects, DH is used to assist aortic arch reconstructions, hypoplastic left heart syndrome interventions, and for multi-stage treatment of infants with a single heart ventricle during the neonatal period. However, it should be noted that a safe duration of circulatory arrest in DH for the central nervous system is 30 to 40 min at most and should not be exceeded to prevent severe neurological adverse events. Personalized therapy for the patient and adequate blood temperature monitoring, glycemia, hematocrit, pH, and cerebral oxygenation is a prerequisite and indispensable part of DH.

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 Branch-first aortic arch replacement with no circulatory arrest or deep hypothermia

2011 ◽  
Vol 142 (4) ◽  
pp. 809-815 ◽  
Author(s):  
George Matalanis ◽  
Rhiannon S. Koirala ◽  
William Y. Shi ◽  
Philip A. Hayward ◽  
Peter R. McCall
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Deep Hypothermia ◽  
Aortic Arch Replacement

scholarly journals Reconstruction Surgery of the Ascending Aorta and the Aortic Arch under Deep Hypothermia with Circulatory Arrest.

1992 ◽  
Vol 21 (3) ◽  
pp. 261-266
Author(s):  
Yoshiyuki HAGA ◽  
Hiroshi YOSHIZU ◽  
Nobuo HATORI ◽  
Eriya OKUDA ◽  
Yozo URIUDA ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Ascending Aorta ◽  
Deep Hypothermia ◽  
Reconstruction Surgery

scholarly journals Sedatives during circulatory arrest are not necessary for aortic arch repair in acute type A aortic dissection

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alexander O. Makkinejad ◽  
Jeffrey Clemence ◽  
Elizabeth L. Norton ◽  
Linda Farhat ◽  
Xiao-Ting Wu ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Aortic Arch Repair

Endovascular Solutions for Aortic Arch Diseases: Total and Hybrid

2021 ◽  
Author(s):  
Luca Marco ◽  
Giacomo Murana ◽  
Luigi Lovato ◽  
Gregorio Gliozzi ◽  
Francesco Buia ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Stent Graft ◽  
Open Surgery ◽  
New Technologies ◽  
Therapeutic Option ◽  
Circulatory Arrest ◽  
Acute Type ◽  
Aortic Diseases ◽  
Increased Risk ◽  
Endovascular Approach

Although the endovascular approach is the therapeutic option of choice for thoracic and abdominal aortic diseases, open surgery is still the treatment of choice for aortic arch diseases. While open surgical repair remains the gold standard treatment for complete aortic arch replacement, it continues to be burdened by high mortality and neurologic complications, especially for patients who require redo surgery. Therefore, in the era of endovascular surgery, it is not surprising that hybrid operating rooms, new technologies, and new approaches are strongly challenging open surgery. Less-invasive endovascular procedures, when used to treat aortic arch diseases, when feasible and indicated, have clear advantages over open surgery, primarily because there is no need for cardiopulmonary bypass, hypothermic circulatory arrest, or cerebral protection. Moreover, patients who have already been treated for acute type A aortic dissection continue to have a considerable risk for future aortic reintervention, which is associated with increased risk for short- and long-term mortality. In light of these advantages, it is clear how selected high-risk patients with aortic arch disease could benefit from the endovascular approach. However, the hemodynamic and anatomic characteristics of the aortic arch make the endovascular approach in this region challenging. In fact, uncorrected stent-graft placement can have fatal consequences for the patient and increase the risk of endoleaks and stroke. To minimize these potential risks, precise and accurate preoperative planning to achieve optimal stent-graft dimensions and implantation is essential together with careful patient selection. Endovascular options for the treatment of aortic arch disease include both hybrid procedures and total endovascular solutions. This manuscript provides an overview of the current strategies for endovascular aortic arch treatment, including the most recent available series on this topic. In addition, a literature search offers insight into the current state of the art.

Aortic Arch Repair (Circulatory Arrest)

2019 ◽  
pp. 263-267
Author(s):  
Shyamal Asher
Keyword(s):  
Blood Flow ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Anesthetic Management ◽  
Deep Hypothermia ◽  
The Body ◽  
Adequate Knowledge ◽  
Aortic Arch Repair ◽  
Aortic Dissections ◽  
The Brain

Aortic arch repair is a technically challenging surgery that requires collaboration between the anesthesiology, cardiac surgery, and perfusion teams. To accomplish a total aortic arch repair, blood flow to the brain and the rest of the body has to be interrupted. The most common aortic arch pathologies encountered for surgery are aortic arch aneurysms followed by aortic dissections. The need for hypothermia and circulatory arrest during aortic arch surgeries leads to unique implications for anesthetic management. Therefore, adequate knowledge of the planned surgery and specific surgical and nonsurgical cerebral protection techniques are necessary. Furthermore, an understanding of intraoperative neurophysiologic and temperature monitoring at deep hypothermia as well as postbypass coagulopathy management are needed in these challenging cases.

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