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Selective Aortic Arch Perfusion

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https://www.readbyqxmd.com/read/28314530/objective-analysis-of-midterm-outcomes-of-conventional-and-hybrid-aortic-arch-repair-by-propensity-score-matching
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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...
November 3, 2016: Perfusion
https://www.readbyqxmd.com/read/27765887/total-aortic-arch-replacement-advantages-of-varied-techniques
#10
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
#11
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
#12
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
https://www.readbyqxmd.com/read/27729705/selective-heart-brain-and-body-perfusion-in-open-aortic-arch-replacement
#13
Sven Maier, Fabian Kari, Bartosz Rylski, Matthias Siepe, Christoph Benk, Friedhelm Beyersdorf
Open aortic arch replacement is a complex and challenging procedure, especially in post dissection aneurysms and in redo procedures after previous surgery of the ascending aorta or aortic root. We report our experience with the simultaneous selective perfusion of heart, brain, and remaining body to ensure optimal perfusion and to minimize perfusion-related risks during these procedures. We used a specially configured heart-lung machine with a centrifugal pump as arterial pump and an additional roller pump for the selective cerebral perfusion...
September 2016: Journal of Extra-corporeal Technology
https://www.readbyqxmd.com/read/27694252/fifteen-years-of-surgery-for-acute-type-a-aortic-dissection-in-moderate-to-mild-systemic-hypothermia%C3%A2
#14
Andreas Zierer, Ali El-Sayed Ahmad, Nestoras Papadopoulos, Faisal Detho, Petar Risteski, Anton Moritz, Anno Diegeler, Paul P Urbanski
OBJECTIVE: Surgery for acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurological morbidity and mortality. The following study investigates the clinical results after surgical treatment for acute type A aortic dissection using selective antegrade cerebral perfusion and moderate-to-mild systemic hypothermia (≥28 °C). METHODS: Between January 2000 and January 2015, 453 consecutive patients underwent surgical treatment for acute type A aortic dissection at two aortic referral centres in Germany...
January 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/27650344/temporary-extracorporeal-bypass-modalities-during-aortic-surgery
#15
REVIEW
Levi Bassin, David Bell
The key to aortic surgery is protection of the brain, heart, spinal cord, and viscera. For operations involving the aortic arch, the focus is on cerebral protection, while for pathology involving the descending thoracic aorta, the focus is on spinal protection. Optimal cerebral and spinal protection requires an extensive knowledge of the operative steps and an understanding of the cardiopulmonary bypass modalities that are possible. A bloodless field is required when operating on the aorta. As a result, periods of ischemia to the central nervous system and end-organ viscera are often unavoidable...
September 2016: Best Practice & Research. Clinical Anaesthesiology
https://www.readbyqxmd.com/read/27637729/predictors-of-adverse-outcome-and-transient-neurological-dysfunction-following-aortic-arch-replacement-in-626-consecutive-patients-in-china
#16
Hong Liu, Qian Chang, HaiTao Zhang, CunTao Yu
BACKGROUND: Early mortality and cerebral injury are severe complications of aortic arch surgery, but data from Asian countries are scarce. We reviewed the results of patients who underwent aortic arch replacement with deep hypothermic circulatory arrest (DHCA) and antegrade selective cerebral perfusion (ASCP) at our institution to analyse pre- and intraoperative predictors of early death and neurological complications. METHODS: Clinical data of adult patients who underwent aortic arch surgery with DHCA plus ASCP between January 2005 and December 2011 were retrospectively analysed...
February 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/27578577/-protective-effects-of-high-dose-ulinastatin-on-vital-organs-in-patients-receiving-total-arch-replacement-for-type-a-aortic-dissection
#17
Xian-Yue Wang, Wen-Peng Dong, Guang Tong, Sheng-Hui Bi, Ben Zhang, Hua Lu, Xiao-Wu Wang, Wei-da Zhang
OBJECTIVE: To investigate the protective effects of high-dose ulinastatin on the vital organs in patients undergoing total arch replacement for type A aortic dissection. METHODS: Between September 2014 and March 2016, 66 patients with type A aortic dissection underwent total arch replacement at our center. Thirty-six of the patients received ulinastatin treatment at 300 000 U/8 h from admission to 3 days postoperatively and at 300 000 U/2 h during cardiopulmonary bypass surgery (UTI group), and the other 30 patients did not receive perioperative ulinastatin treatment (control group)...
August 20, 2016: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
https://www.readbyqxmd.com/read/27568130/open-aortic-arch-reconstruction-after-coronary-artery-bypass-surgery-worth-the-effort
#18
Eduard Quintana, Pietro Bajona, Hartzell V Schaff, Joseph A Dearani, Richard Daly, Kevin Greason, Alberto Pochettino
Open aortic arch surgery after coronary artery bypass grafting (CABG) is considered a high-risk operation. We reviewed our surgical approach and outcomes to establish the risk profile for this patient population. In methods, from 2000-2014, 650 patients underwent aortic arch surgery with circulatory arrest. Of these, 45 (7%) had previous CABG. Complete medical record was available for review including all preoperative coronary angiograms and detailed management of myocardial protection. In results, the mean interval from previous CABG to aortic arch surgery was 6...
December 0: Seminars in Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27501694/optimal-temperature-management-in-aortic-arch-operations
#19
REVIEW
Michael O Kayatta, Edward P Chen
Hypothermic circulatory arrest is a critical component of aortic arch procedures, without which these operations could not be safely performed. Despite the use of hypothermia as a protective adjunct for organ preservation, aortic arch surgery remains complex and is associated with numerous complications despite years of surgical advancement. Deep hypothermic circulatory arrest affords the surgeon a safe period of time to perform the arch reconstruction, but this interruption of perfusion comes at a high clinical cost: stroke, paraplegia, and organ dysfunction are all potential-associated complications...
November 2016: General Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/27431991/efficacy-of-limited-proximal-arch-replacement-for-type-a-acute-aortic-dissection-with-critical-complications
#20
Mitsumasa Hata, Yukihiko Orime, Shinji Wakui, Tetsuya Nakamura, Rei Hinoura, Kenji Akiyama
OBJECTIVE: We assessed the efficacy of limited proximal arch replacement for type A acute aortic dissection (AAD) with critical complications. METHODS: Sixty-four patients with average age of 64.5 ± 13.0 years, who were intubated prior to arriving at hospital due to cardiopulmonary arrest, cardiac tamponade, or vital organ mal-perfusion, were divided into two groups: group PA consisted of 52 patients undergoing proximal arch repair with mild hypothermic circulatory arrest; group TA consisted of 12 patients who underwent total arch replacement with moderate hypothermia and selective cerebral perfusion...
November 2016: General Thoracic and Cardiovascular Surgery
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