Faculty Opinions recommendation of Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients.

2012 ◽  
Author(s):  
Sergio Bergese ◽  
Joseph Werner
Keyword(s):  
Circulatory Arrest ◽  
Meta Analysis ◽  
Aortic Surgery ◽  
Cerebral Protection

scholarly journals Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: A meta-analysis of 5100 patients

2014 ◽  
Vol 147 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Emiliano Angeloni ◽  
Umberto Benedetto ◽  
Johanna J.M. Takkenberg ◽  
Ivan Stigliano ◽  
Antonino Roscitano ◽  
...  
Keyword(s):  
Circulatory Arrest ◽  
Meta Analysis ◽  
Aortic Surgery ◽  
Cerebral Protection

Evaluating the Quality of Trials of Hypothermic Circulatory Arrest Aortic Surgery

2007 ◽  
Vol 15 (5) ◽  
pp. 449-452 ◽  
Author(s):  
Jeffrey H Shuhaiber
Keyword(s):  
Randomized Controlled Trials ◽  
Circulatory Arrest ◽  
Meta Analysis ◽  
Aortic Surgery ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Neurological Deficits ◽  
Controlled Trials ◽  
Randomized Controlled

The quality of level 1 evidence in reports on deep hypothermic circulatory arrest was assessed, and the confounding factors in surgical management and study design that can prevent meta-analysis formulation were determined. A systematic search of the literature was conducted using categorized nomenclature for randomized controlled trials in adult patients undergoing deep hypothermic circulatory arrest in the last 40 years. Twelve randomized controlled trials (2.3%) were found among 504 publications on deep hypothermic circulatory arrest listed on Medline from 1960; only 4 of them related to adults. One adequately powered study demonstrated reduced blood loss in deep hypothermic circulatory arrest using aprotinin. Three studies comparing retrograde and antegrade perfusion were underpowered. The median CONSORT score was 14 (range, 13–15). There were no consistent measures of similar outcomes (neuropsychometric, neurocognitive). No explanation was provided for the difference in reported ranges of neurological deficits in nonrandomized (5%–70%) and randomized (3%–9%) studies. Existing studies of deep hypothermic circulatory arrest are insufficient and inconsistent in the outcome measured, which explains the lack of a meta-analysis. Neurological injury remains high, and an appropriately powered study of interventions that can optimize cerebral perfusion is necessary.

scholarly journals Unilateral Versus Bilateral Antegrade Cerebral Protection During Aortic Surgery: An Updated Meta-Analysis

2015 ◽  
Vol 99 (6) ◽  
pp. 2024-2031 ◽  
Author(s):  
Emiliano Angeloni ◽  
Giovanni Melina ◽  
Simone K. Refice ◽  
Antonino Roscitano ◽  
Fabio Capuano ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Aortic Surgery ◽  
Cerebral Protection

Integrated Cerebral Protection Combined Antegrade and Retrograde Cerebral Perfusion during Deep Hypothermic Circulatory Arrest

2010 ◽  
Vol 5 (5) ◽  
pp. 355-358 ◽  
Author(s):  
James S. Gammie ◽  
Britney Landree ◽  
Bartley P. Griffith
Keyword(s):  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Hypothermic Circulatory Arrest ◽  
Cerebral Protection ◽  
Acute Type ◽  
Brain Protection ◽  
Retrograde Cerebral Perfusion ◽  
Clinical Series ◽  
The Mean

Objective Aortic arch surgery requires temporary interruption of cerebral perfusion. Hypothermic circulatory arrest (HCA) is an established method of central nervous system protection for limited periods of absent cerebral blood flow. Adjuncts to increase the safe duration of circulatory arrest include either retrograde cerebral perfusion (RCP) or antegrade cerebral perfusion (ACP), with most complex aortic operations now performed using HCA with ACP. We reasoned that optimal cerebral protection might be achieved with a combination of ACP and RCP (integrated brain protection) and present an early clinical experience that supports this approach. Methods The integrated brain protection strategy included sequential overlapping periods of RCP, ACP, and RCP during HCA. Moderate systemic hypothermia (25°C) was used. Patient data were gathered through retrospective chart review. Results Between 2008 and 2009, six consecutive patients underwent ascending aortic graft replacement for acute type A dissection using HCA and integrated brain protection. The mean minimum systemic temperature was 22.9 ± 1.8°C, the mean total HCA time was 34 ± 5 minutes, and the mean duration of ACP and RCP was 22 ± 6 and 7 ± 5 minutes, respectively. Patients were awake and followed commands 10.1 ± 3.4 (range, 5–13) hours after operation, and there was no evidence of temporary neurologic dysfunction. There was no operative mortality. Conclusions Integrated brain protection using both RCP and ACP during HCA is a promising approach for the safe performance of complex aortic surgery and is worthy of evaluation in larger clinical series.

scholarly journals Neuroprotective strategies with circulatory arrest in open aortic surgery – A meta-analysis

2022 ◽  
pp. 021849232110691
Author(s):  
Imthiaz Manoly ◽  
Mohsin Uzzaman ◽  
Dimos Karangelis ◽  
Manoj Kuduvalli ◽  
Efstratios Georgakarakos ◽  
...  
Keyword(s):  
Renal Failure ◽  
Hospital Stay ◽  
Circulatory Arrest ◽  
Meta Analysis ◽  
Aortic Surgery ◽  
Length Of Hospital Stay ◽  
Pulmonary Complications ◽  
Hypothermic Circulatory Arrest ◽  
Transfusion Requirements ◽  
Secondary Outcomes

Objective Deep hypothermic circulatory arrest (DHCA) in aortic surgery is associated with morbidity and mortality despite evolving strategies. With the advent of antegrade cerebral perfusion (ACP), moderate hypothermic circulatory arrest (MHCA) was reported to have better outcomes than DHCA. There is no standardised guideline or consensus regarding the hypothermic strategies to be employed in open aortic surgery. Meta-analysis was performed comparing DHCA with MHCA + ACP in patients having aortic surgery. Methods A systematic review of the literature was undertaken. Any studies with DHCA versus MHCA + ACP in aortic surgeries were selected according to specific inclusion criteria and analysed to generate summative data. Statistical analysis was performed using STATS Direct. The primary outcomes were hospital mortality and post-operative stroke. Secondary outcomes were cardiopulmonary bypass time (CPB), post-operative blood transfusion, length of ICU stay, respiratory complications, renal failure and length of hospital stay. Subgroup analysis of primary outcomes for Arch surgery alone was also performed. Results Fifteen studies were included with a total of 5869 patients. There was significantly reduced mortality (Pooled OR = +0.64, 95% CI = +0.49 to +0.83; p = 0.0006) and stroke rate (Pooled OR = +0.62, 95% CI = +0.49 to +0.79; p < 0.001) in the MHCA group. MHCA was associated significantly with shorter CPB times, shorter duration in ICU, less pulmonary complications, and reduced rates of sepsis. There was no statistical difference between the two groups in terms of circulatory arrest times, X-Clamp times, total operation duration, transfusion requirements, renal failure and post-op hospital stay. Conclusion MHCA + ACP are associated with significantly better post-operative outcomes compared with DHCA for both mortality and stroke and majority of the secondary outcomes.

Sign in / Sign up

Export Citation Format

Share Document