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Selective Aortic Arch Perfusion

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https://www.readbyqxmd.com/read/28637170/neuroprotective-effect-of-pressure-oriented-flow-regulation-and-ph-stat-management-in-selective-antegrade-brain-perfusion-during-total-aortic-arch-repair
#1
Hisato Ito, Toru Mizumoto, Yasuhiro Sawada, Kazuya Fujinaga, Hironori Tempaku, Yasunori Yamamoto, Katsuhiro Tsutsui, Hideto Shimpo
OBJECTIVES: The aim of this study was to assess the safety and effectiveness of our selective antegrade brain perfusion (SABP) strategy, which is characterized by moderate hypothermic and low-pressure management under pH-stat using a completely closed cardiopulmonary bypass circuit with a single centrifugal pump. METHODS: Forty-nine consecutive patients (median age, 74) underwent total aortic arch replacement using a 4-branched graft. SABP was conducted with individual cannulation in all arch vessels...
June 20, 2017: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/28616347/intraoperative-care-for-aortic-surgery-using-circulatory-arrest
#2
REVIEW
Félix Ezequiel Fernández Suárez, David Fernández Del Valle, Adrián González Alvarez, Blanca Pérez-Lozano
The total circulatory arrest (CA) is necessary to achieve optimal surgical conditions in certain aortic pathologies, especially in those affecting the ascending aorta and aortic arch. During this procedure it is necessary to protect all the organs of ischemia, especially those of the central nervous system and for this purpose several strategies have been developed. The first and most important protective method is systemic hypothermia. The degree of hypothermia and the route of application have been evolving and currently tend to use moderate hypothermia (MH) (20...
May 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28551049/hypothermia-and-selective-antegrade-cerebral-perfusion-is-safe-for-arch-repair-in-type-a-dissection
#3
W Brent Keeling, Bradley G Leshnower, John C Hunting, Jose Binongo, Edward P Chen
BACKGROUND: Unilateral selective antegrade cerebral perfusion with moderate hypothermic circulatory arrest has been shown to be a safe and effective method of cerebral protection during surgery for acute type A dissection. This study evaluates the impact of this cerebral protection strategy on clinical outcomes after extended aortic arch reconstruction in patients undergoing emergent repair of acute type A dissection. METHODS: A retrospective review from 2004 to 2016 at a US academic center of patients undergoing surgery for acute type A dissections using moderate hypothermic circulatory arrest and selective antegrade cerebral perfusion was performed...
May 24, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28496083/-retrograde-type-a-aortic-dissection-after-thoracic-endovascular-aortic-repair-report-of-a-case
#4
Sei Morizumi, Takafumi Inoue, Satoshi Nishi, Akihiro Yoshimoto, Masashi Fujisaki, Yoshihiro Suematsu
A 72-year-old man presented with aneurysms of the distal aortic arch and the distal descending aorta due to chronic type B aortic dissection. We first performed thoracic endovascular aortic repair (TEVAR) in the distal descending aorta, and the aneurysm was successfully excluded using a Gore Tag stentgraft. Seven days after TEVAR, computed tomography revealed retrograde type A aortic dissection occurring from the ascending aorta to the distal aortic arch. In emergency surgery, ascending aorta and total arch replacement were performed under selective cerebral perfusion with moderate hypothermia, and after coming off cardiopulmonary bypass, the distal aortic arch aneurysm was excluded using a Gore Tag stentgraft...
May 2017: Kyobu Geka. the Japanese Journal of Thoracic Surgery
https://www.readbyqxmd.com/read/28411747/the-impact-of-carotid-or-intracranial-atherosclerosis-on-perioperative-stroke-in-patients-undergoing-open-aortic-arch-surgery
#5
Ken-Ichi Imasaka, Eiki Tayama, Yukihiro Tomita
OBJECTIVES: This study aimed to clarify the impact of carotid or intracranial atherosclerosis on perioperative stroke in patients undergoing open aortic arch surgery. METHODS: Between 2008 and 2015, 200 consecutive patients underwent elective aortic arch surgery with selective antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Nonselective screening for carotid or intracranial atherosclerosis was performed using carotid ultrasonography or magnetic resonance angiography...
May 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28359507/a-novel-arterial-cannulation-technique-for-selective-regional-cerebral-perfusion
#6
Hyungtae Kim, Si Chan Sung, Kwang Ho Choi
A selective regional cerebral perfusion has been widely adopted for brain protection in neonatal or infant aortic arch surgeries. The anastomosis of the small polytetrafluoroethylene tube graft to the innominate artery has been used for the selective regional cerebral perfusion in many institutions. We have developed a specially designed cannula tip that allows bidirectional blood flow and provides secure positioning of the polytetrafluoroethylene tube graft at the innominate artery. Innominate artery cannulation using this device reduces arterial clamping time and permits us to perform the arterial cannulation in a much easier and secure manner...
April 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28355763/-late-reoperations-after-repaired-stanford-type-a-aortic-dissection
#7
F H Huang, L P Li, C H Su, W Qin, M Xu, L M Wang, Y S Jiang, Z B Qiu, L Q Xiao, C Zhang, H W Shi, X Chen
Objective: To summarize the experience of reoperations on patients who had late complications related to previous aortic surgery for Stanford type A dissection. Methods: From August 2008 to October 2016, 14 patients (10 male and 4 female patients) who underwent previous cardiac surgery for Stanford type A aortic dissection accepted reoperations on the late complications at Department of Thoracic and Cardiovascular Surgery, Nanjing Hospital Affiliated to Nanjing Medical University. The range of age was from 41 to 76 years, the mean age was (57±12) years...
April 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28355758/-progress-and-challenge-of-stanford-type-a-aortic-dissection-in-china
#8
L Z Sun, J R Li
In recent 20 years, the rapid development of acute Stanford type A aortic dissection in China has been mainly due to three aspects: (1) the refined classification of aortic dissection based on Stanford classification, (2) right axillary artery canal and selective cerebral perfusion technology become basic cardiopulmonary bypass strategy for Stanford type A aortic dissection, and (3) total aortic arch replacement and descending aortic stent graft surgery (Sun's surgery) become the standard treatment of Stanford type A aortic dissection...
April 1, 2017: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
https://www.readbyqxmd.com/read/28314530/objective-analysis-of-midterm-outcomes-of-conventional-and-hybrid-aortic-arch-repair-by-propensity-score-matching
#9
Arudo Hiraoka, Genta Chikazawa, Toshinori Totsugawa, Kentaro Tamura, Atsuhisa Ishida, Taichi Sakaguchi, Hidenori Yoshitaka
OBJECTIVE: The aim of this study is to evaluate the objective outcomes of conventional total aortic arch repair (CTAR) and hybrid arch repair by using propensity-score matching to reduce selection bias. METHODS: Between January 2006 and April 2016, 470 consecutive patients underwent isolated aortic arch repair (excluding hemiarch or partial arch reconstruction, and cases with concomitant cardiac surgeries) at a single cardiovascular institute. We categorized 337 total aortic arch repair with antegrade cerebral perfusion under circulatory arrest as the CTAR group and 58 hybrid aortic arch repair (HAR) with thoracic endovascular aortic repair as the HAR group...
February 10, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28132587/aortic-arch-reconstruction-deep-and-moderate-hypothermic-circulatory-arrest-with-selective-antegrade-cerebral-perfusion
#10
YanWen Wu, LiQiong Xiao, Ting Yang, Lei Wang, Xin Chen
OBJECTIVE: To compare the effects of moderate and deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (SACP) during aortic arch surgery in adult patients and to offer the evidence for the detection of the temperature which provides best brain protection in the subjects who accept aortic arch reconstruction surgery. METHODS: A total of 109 patients undergoing surgery of the aortic arch were divided into the moderate hypothermic circulatory arrest group (Group I) and the deep hypothermic circulatory arrest group (Group II)...
January 1, 2017: Perfusion
https://www.readbyqxmd.com/read/28131431/the-standardized-concept-of-moderate-to-mild-%C3%A2-28%C3%A2-c-systemic-hypothermia-during-selective-antegrade-cerebral-perfusion-for%C3%A2-all-comers-in-aortic-arch-surgery-single-center-experience-in-587-consecutive-patients-over-a-15-year-period
#11
Ali El-Sayed Ahmad, Nestoras Papadopoulos, Petar Risteski, Anton Moritz, Andreas Zierer
BACKGROUND: Whether selective antegrade cerebral perfusion (ACP) during moderate-to-mild systemic hypothermia (≥28°C) is applicable to aortic arch surgery without restrictions including the emergency setting of an acute type A aortic dissection or extensive total arch procedures such as elephant and frozen elephant trunk techniques is an ongoing subject of controversy. METHODS: Between January 2000 and January 2015, 587 consecutive all-comers underwent aortic arch surgery at our institution uniformly applying selective ACP (unilateral: n = 393 [67%]; bilateral: n = 194 [33%]) during moderate-to-mild systemic hypothermia (28...
January 25, 2017: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/28108567/role-of-the-frozen-elephant-trunk-procedure-for-chronic-aortic-dissection
#12
REVIEW
Eric E Roselli, Faisal G Bakaeen, Douglas R Johnston, Edward G Soltesz, Michael Z Tong
OBJECTIVES: Considering the chronic and progressive nature of aortic dissection, operative planning must anticipate the need for later interventions. We have increasingly used a modified version of the frozen elephant trunk repair operation to treat these patients. We review the indications, considerations for planning, and important operative details for performing frozen elephant trunk repair for chronic aortic dissection. METHODS: Frozen elephant trunk repair is performed using selective antegrade brain perfusion, direct placement of commercially available stent grafts with suture fixation in the aortic arch, and proximal aortic replacement...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/28040765/classification-and-outcomes-of-extended-arch-repair-for-acute-type-a-aortic-dissection-a-systematic-review-and-meta-analysis
#13
REVIEW
Holly N Smith, Munir Boodhwani, Maral Ouzounian, Richard Saczkowski, Alexander J Gregory, Eric J Herget, Jehangir J Appoo
OBJECTIVES: Distal extent of repair in patients undergoing surgery for acute Type A aortic dissection (ATAAD) is controversial. Emerging hybrid techniques involving open and endovascular surgery have been reported in small numbers by select individual centres. A systematic review and meta-analysis was performed to investigate the outcomes following extended arch repair for ATAAD. A classification system is proposed of the different techniques to facilitate discussion and further investigation...
December 31, 2016: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/27843111/a-comprehensive-review-of-in-situ-fenestration-of-aortic-endografts
#14
REVIEW
M Glorion, R Coscas, R G McWilliams, I Javerliat, O Goëau-Brissonniere, M Coggia
OBJECTIVE: Despite technical advances of fenestrated and branched endografts, endovascular exclusion of aneurysms involving renal, visceral, and/or supra-aortic branches remains a challenge. In situ fenestration (ISF) of standard endografts represents another endovascular means to maintain perfusion to such branches. This study aimed to review current indications, technical descriptions, and results of ISF. METHOD: A review of the English language literature was performed in Medline databases, Cochrane Database, Web of Science, and Scopus using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines...
December 2016: European Journal of Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/27825691/long-term-outcomes-of-open-arch-repair-after-a-prior-aortic-operation-our-experience-in-154-patients
#15
Roberto Di Bartolomeo, Paolo Berretta, Antonio Pantaleo, Giacomo Murana, Mariano Cefarelli, Jacopo Alfonsi, Giuseppe Barberio, Alessandro Leone, Luca Di Marco, Davide Pacini
BACKGROUND: This study assessed the early and long-term results of arch operations performed after a prior aortic operation. METHODS: From 1994 to 2014, 154 consecutive patients (mean age, 59.7 years) underwent an aortic arch repair, after a previous aortic operation, at our institution. Antegrade selective cerebral perfusion was used in all cases. Chronic postdissection aortic aneurysm (87 [56.5%]) and degenerative aneurysm (43 [27.9%]) represented the most common indications for surgical intervention...
November 5, 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27821787/arterial-cannulation-and-cerebral-perfusion-strategies-for-aortic-arch-operations
#16
REVIEW
Lisa S Foley, Katsuhiro Yamanaka, T Brett Reece
Neurologic injuries following aortic arch operations can be devastating, with stroke occurring in up to 12% of elective operations and significant cerebral dysfunction occurring in up to 25% of cases. The primary challenge unique to aortic arch operations involves interruption of direct perfusion of the brachiocephalic vessels during arch reconstruction. For this reason, neuroprotection is paramount. The 2 main modes of protection are (1) reducing metabolic demand through hypothermia and (2) limiting, or even eliminating, the ischemic period...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27815557/whole-body-perfusion-for-hybrid-aortic-arch-repair-evolution-of-selective-regional-perfusion-with-a-modified-extracorporeal-circuit
#17
Philip Fernandes, Graham Walsh, Stephanie Walsh, Michael O'Neil, Jill Gelinas, Michael W A Chu
BACKGROUND: Patients undergoing hybrid aortic arch reconstruction require careful protection of vital organs. We believe that whole body perfusion with tailored dual circuitry may help to achieve optimal patient outcomes. METHODS: Our circuit has evolved from a secondary circuit utilizing a cardioplegia delivery device for lower body perfusion to a dual-oxygenator circuit. This allows individually controlled regional perfusion with ease of switching from secondary to primary circuit for total body flow...
April 2017: Perfusion
https://www.readbyqxmd.com/read/27765887/total-aortic-arch-replacement-advantages-of-varied-techniques
#18
REVIEW
Ryan C Shelstad, Justin G Reeves, Katsuhiro Yamanaka, T Brett Reece
We review the operative techniques of aortic arch replacement. Aortic arch replacement presents several formidable challenges, as it requires arresting the circulation to the body and replacement of the brachiocephalic vessels with special consideration for protecting the central nervous system. Perfusion strategies, selective antegrade cerebral perfusion, and operative graft selection are key elements in aortic arch replacement surgery. Standard approaches include the island technique, the branched graft technique, and the "Spielvogel" trifurcated graft technique-each having its own advantages...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27742818/a-clinical-protocol-for-goal-directed-cerebral-perfusion-during-aortic-arch-surgery
#19
REVIEW
Matthew S Mosca, George Justison, T Brett Reece
OBJECTIVE: The optimal strategy to deliver antegrade cerebral perfusion for cerebral protection during hypothermic circulatory arrest has not been established. The purpose of this review was to present our current clinical protocol utilizing selective antegrade cerebral perfusion during aortic arch surgery and to compare it to other published experience. CLINICAL PROTOCOL: Since 2013, our clinical protocol for aortic arch surgery has evolved to using selective antegrade cerebral perfusion via the innominate artery, moderate hypothermia, and ancillary strategies such as goal-directed perfusion (GDP)...
December 2016: Seminars in Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/27734011/neurologic-injury-associated-with-rewarming-from-hypothermia-is-mild-hypothermia-on-bypass-better-than-deep-hypothermic-circulatory-arrest
#20
Utpal S Bhalala, Elumalai Appachi, Muhammad Ali Mumtaz
Many known risk factors for adverse cardiovascular and neurological outcomes in children with congenital heart defects (CHD) are not modifiable; however, the temperature and blood flow during cardiopulmonary bypass (CPB), are two risk factors, which may be altered in an attempt to improve long-term neurological outcomes. Deep hypothermic circulatory arrest, traditionally used for aortic arch repair, has been associated with short-term and long-term neurologic sequelae. Therefore, there is a rising interest in using moderate hypothermia with selective antegrade cerebral blood flow on CPB during aortic arch repair...
2016: Frontiers in Pediatrics
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