PROTECTION OF CENTRAL AND PERIPHERAL ORGANS IN AORTIC SURGERY

2020 ◽  
pp. 19-23
Author(s):  
Olha Volodymyrivna Buchnieva
Keyword(s):  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Original Method ◽  
Moderate Hypothermia ◽  
Organ Protection ◽  
Results Of Treatment ◽  
Post Surgery ◽  
Visceral Arteries ◽  
Systemic Hypothermia ◽  
Selective Perfusion

The introduction into clinical practice of hypothermic circulatory arrest, both in the non−perfusion version and with an artificial circulation, was the beginning of active use of systemic hypothermia as an effective element of cerebral and visceral protection during combined cardiac surgeries, including in aorta pathology. To evaluate ways of protecting visceral organs and spinal cord, namely the "no perfusion" technique with drainage of cerebrospinal fluid, lateral aortic compression, left−atrial−femoral bypass, deep hypothermia with cardiac arrest, i.e. hypothermic circulatory arest, bypass grafting, artificial blood circulation and moderate hypothermia in surgery for acute aortic syndrome the results of treatment of the patients with acute bundle aortic aortic abdominal localization were analyzed. There was characterized the proposed and implemented in practice original method of protection, consisting in an access to aorta, which is pressed above the aneurysm at the level of bifurcation, and selective perfusion into the mouth of vessels supplying the internal organs with a custodiol solution with a temperature of 3−4°. All the patients with combined occlusion−stenotic lesions of different arterial pools have aortic prostheses with the inclusion of visceral arteries into bloodstream in different variants. The tendency of the more favorable post−surgery period in the patients to whom the implemented methods of protection were applied. Key words: aortic aneurysm, surgical treatment, organ protection.

scholarly journals Does deeper hypothermia reduce the risk of acute kidney injury after circulatory arrest for aortic arch surgery?

2021 ◽  
Author(s):  
Andrew M Vekstein ◽  
Babtunde A Yerokun ◽  
Oliver K Jawitz ◽  
Julie W Doberne ◽  
Jatin Anand ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Multivariable Analysis ◽  
Kidney Injury ◽  
Deep Hypothermia ◽  
Moderate Hypothermia ◽  
Bladder Temperature ◽  
Increased Risk ◽  
The Impact

Abstract OBJECTIVES The impact of hypothermic circulatory arrest (HCA) temperature on postoperative acute kidney injury (AKI) has not been evaluated. This study examined the association between circulatory arrest temperatures and AKI in patients undergoing proximal aortic surgery with HCA. METHODS A total of 759 consecutive patients who underwent proximal aortic surgery (ascending ± valve ± root) including arch replacement requiring HCA between July 2005 and December 2016 were identified from a prospectively maintained institutional aortic surgery database. The primary outcome was AKI as defined by Risk, Injury, Failure, Loss, End Stage Renal Disease (ESRD) criteria. The association between minimum nasopharyngeal (NP) and bladder temperatures during HCA and postoperative AKI was assessed, adjusting for patient-level factors using multivariable logistic regression. RESULTS A total of 85% (n = 645) of patients underwent deep hypothermia (14.1–20.0°C), 11% (n = 83) low-moderate hypothermia (20.1–24.0°C) and 4% (n = 31) high-moderate hypothermia (24.1–28.0°C) as classified by NP temperature. When analysed by bladder temperature, 59% (n = 447) underwent deep hypothermia, 22% (n = 170) low-moderate, 16% (n = 118) high-moderate and 3% mild (n = 24) (28.1–34.0°C) hypothermia. The median systemic circulatory arrest time was 17 min. The incidence of AKI did not differ between hypothermia groups, whether analysed using minimum NP or bladder temperature. In the multivariable analysis, the association between degree of hypothermia and AKI remained non-significant whether analysed as a categorical variable (hypothermia group) or as a continuous variable (minimum NP or bladder temperature) (all P > 0.05). CONCLUSIONS In patients undergoing proximal aortic surgery including arch replacement requiring HCA, degree of systemic hypothermia was not associated with the risk of AKI. These data suggest that moderate hypothermia does not confer increased risk of AKI for patients requiring circulatory arrest, although additional prospective data are needed.

scholarly journals Rethinking the Paradigm: Modern Approach to Proximal Aortic Reconstruction Demonstrates Excellent Outcomes

2017 ◽  
Vol 20 (3) ◽  
pp. 092 ◽  
Author(s):  
Jonathan M Hemli ◽  
Edward R. R. DeLaney ◽  
Kush R. Dholakia ◽  
Dror Perk ◽  
Nirav C. Patel ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Elective Surgery ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Ascending Aorta ◽  
Aortic Root Replacement ◽  
Aortic Aneurysms ◽  
Moderate Hypothermia ◽  
Modern Approach ◽  
Modern Era

Background: Techniques for aortic surgery continue to evolve. A real-world snapshot of patients undergoing elective surgery for aneurysm in the modern era is helpful to assist in deciding the appropriate timing for intervention. We herein describe our experience with 100 consecutive patients who underwent primary elective surgery for aneurysm of the proximal thoracic aorta over a two-year period at a single institution.Methods: The majority of our patients were male, mean age 61.19 ± 13.33 years. Two patients had Marfan syndrome. Twenty-eight patients had bicuspid aortic valve. Thirty-four patients underwent aortic root replacement utilizing a composite valve/graft conduit; 23 had valve-sparing root replacements. The ascending aorta was replaced in 89 patients; 80 (89.9%) of these included a period of circulatory arrest at moderate hypothermia utilizing unilateral selective antegrade cerebral perfusion.Results: Thirty-day mortality was zero. Perioperative stroke occurred in 2 patients, both of whom completely recovered prior to discharge. No patients required re-exploration for bleeding. One patient developed a sternal wound infection. Fifteen patients required readmission to hospital within thirty days of discharge.Conclusion: Elective surgery for aneurysm of the proximal aorta is safe, reproducible, and is associated with outcomes that are superior to those seen in an acute aortic syndrome. It may be appropriate to offer surgery to younger patients with proximal aortic aneurysms at smaller diameters, even if their aortic dimensions do not yet meet traditional guidelines for surgical intervention.

Mild-to-moderate hypothermia for organ protection in aortic arch surgery with circulatory arrest

2011 ◽  
Vol 59 (S 01) ◽  
Author(s):  
PP Urbanski ◽  
A Lenos ◽  
P Bougioukakis ◽  
I Neophytou ◽  
M Zacher ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Organ Protection ◽  
Aortic Arch Surgery

scholarly journals Pulmonary effects of dexmedetomidine infusion in thoracic aortic surgery under hypothermic circulatory arrest: a randomized placebo-controlled trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Seongsu Kim ◽  
Soo Jung Park ◽  
Sang Beom Nam ◽  
Suk-Won Song ◽  
Yeonseung Han ◽  
...  
Keyword(s):  
Partial Pressure ◽  
Controlled Trial ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Hypothermic Circulatory Arrest ◽  
Lung Mechanics ◽  
Anesthesia Induction ◽  
Protective Agent ◽  
Thoracic Aortic Surgery ◽  
Dexmedetomidine Infusion

AbstractDexmedetomidine has emerged as a promising organ protective agent. We performed prospective randomized placebo-controlled trial investigating effects of perioperative dexmedetomidine infusion on pulmonary function following thoracic aortic surgery with cardiopulmonary bypass and moderate hypothermic circulatory arrest. Fifty-two patients were randomized to two groups: the dexmedetomidine group received 1 µg/kg of dexmedetomidine over 20 min after induction of anesthesia, followed by 0.5 µg/kg/h infusion until 12 h after aortic cross clamp (ACC)-off, while the control group received the same volume of normal saline. The primary endpoints were oxygenation indices including arterial O2 partial pressure (PaO2) to alveolar O2 partial pressure ratio (a/A ratio), (A–a) O2 gradient, PaO2/FiO2 and lung mechanics including peak inspiratory and plateau pressures and compliances, which were assessed after anesthesia induction, 1 h, 6 h, 12 h, and 24 h after ACC-off. The secondary endpoints were serum biomarkers including interleukin-6, tumor necrosis factor-α, superoxide dismutase, and malondialdehyde (MDA). As a result, dexmedetomidine did not confer protective effects on the lungs, but inhibited elevation of serum MDA level, indicative of anti-oxidative stress property, and improved urine output and lower requirements of vasopressors.

Severity and Duration of Metabolic Acidosis After Deep Hypothermic Circulatory Arrest for Thoracic Aortic Surgery

2015 ◽  
Vol 29 (6) ◽  
pp. 1432-1440 ◽  
Author(s):  
Kamrouz Ghadimi ◽  
Jacob T. Gutsche ◽  
Samuel L. Setegne ◽  
Kirk R. Jackson ◽  
John G.T. Augoustides ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Thoracic Aortic Surgery

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 PERMANENT NEUROLOGIC DEFICIT AFTER CIRCULATORY ARREST FOR ASCENDING AORTIC SURGERY

1999 ◽  
Vol 88 (Supplement) ◽  
pp. 19SCA
Author(s):  
S Ang ◽  
G Koski ◽  
&NA; Hilgenberg ◽  
&NA; D'Ambra
Keyword(s):  
Circulatory Arrest ◽  
Aortic Surgery ◽  
Neurologic Deficit

scholarly journals Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes

2020 ◽  
Vol 23 (6) ◽  
pp. E803-E808
Author(s):  
Petar Risteski ◽  
Medhat Radwan ◽  
Gjoko Boshkoski ◽  
Razan Salem ◽  
Annarita Iavazzo ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Median Sternotomy ◽  
Minimal Invasive ◽  
Minimal Access ◽  
Organ Protection ◽  
Elephant Trunk ◽  
Aortic Arch Surgery ◽  
Cord Injury ◽  
Systemic Hypothermia ◽  
Aortic Arch Repair

Background: Reports of minimal invasive aortic arch surgery are scarce. We reviewed our experience with minimal access aortic arch surgery performed through an upper mini-sternotomy, with emphasis on details of operative technique and early and mid-term outcomes. Methods: The medical records of 123 adult patients (mean age 66 ± 12 years), who underwent primary elective minimal access aortic arch surgery in two aortic referral centers, were reviewed. The most common indication was degenerative aortic arch aneurysm in 92 (75%) patients. Standard operative and organ protection techniques used in all patients were upper mini-sternotomy, uninterrupted antegrade cerebral perfusion, and moderate systemic hypothermia (27.4 ± 1°C). Results: Sixty-eight (55%) patients received partial aortic arch replacement; the remaining 55 (45%) patients received total arch replacement, further extended with either a frozen elephant trunk in 43 (35%) patients or a conventional elephant trunk procedure in nine (7%) patients. No conversion to full sternotomy was required. New permanent renal failure occurred in one (0.8%) patient, stroke in two (1.6%), and spinal cord injury in four (3.3%) patients. Early mortality was observed in four (3.3%) patients. At five years, survival was 80 ± 6% and freedom from reoperation was 96 ± 3%. Conclusion: Minimal invasive aortic arch repair through an upper mini-sternotomy can be safely performed, with early and mid-term outcomes well comparable to series performed through a standard median sternotomy.

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