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Deep hypothermic circulatory arrest

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https://www.readbyqxmd.com/read/29781589/right-mini-thoracotomy-bentall-with-traditional-and-automated-suturing-devices
#1
Carl Johnson, Juan Siordia, Davida Robinson, Peter Knight
Bentall procedures are traditionally performed through a median sternotomy. However, minimally invasive approaches are increasingly being utilized. A right mini-thoracotomy approach may improve postoperative recovery.  A 5-cm mini-thoracotomy is performed in the right 2nd intercostal space. A camera port is placed lateral to this incision. Peripheral cannulation is performed. The ascending aorta is cross-clamped. Cardioplegia is administered and the patient is placed in deep hypothermic circulatory arrest to construct the distal aortic anastomosis...
May 18, 2018: Multimedia Manual of Cardiothoracic Surgery: MMCTS
https://www.readbyqxmd.com/read/29780723/cerebral-perfusion-issues-in-type-a-aortic-dissection
#2
REVIEW
Davide Pacini, Giacomo Murana, Luca Di Marco, Marianna Berardi, Carlo Mariani, Giuditta Coppola, Mariafrancesca Fiorentino, Alessandro Leone, Roberto Di Bartolomeo
Stroke events are very common in acute type A aortic dissection. Cerebral malperfusion could manifest at presentation due to prolonged arch vessels hypoperfusion or develop after surgery for inadequate cerebral protection during arch repair. To reduce this detrimental complication there are several adjuncts that can be adopted for cerebral protection such as direct antegrade or retrograde cerebral perfusion (RCP) and use period of deep to moderate hypothermic circulatory arrest time; however, they are often insufficient as preoperative malperfusion already caused irreversible ischemic damages...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29732365/corticosteroids-in-pediatric-heart-surgery-myth-or-reality
#3
REVIEW
Daniel P Fudulu, Ben Gibbison, Thomas Upton, Serban C Stoica, Massimo Caputo, Stafford Lightman, Gianni D Angelini
Background: Corticosteroids have been administered prophylactically for more than 60 years in pediatric heart surgery, however, their use remains a matter of debate. There are three main indications for corticosteroid use in pediatric heart surgery with the use of cardiopulmonary bypass (CPB): (1) to blunt the systemic inflammatory response (SIRS) induced by the extracorporeal circuit; (2) to provide perioperative supplementation for presumed relative adrenal insufficiency; (3) for the presumed neuroprotective effect during deep hypothermic circulatory arrest operations...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29730345/hemiarch-reconstruction-vs-clamped-aortic-anastomosis-for-concomitant-ascending-aortic-aneurysm
#4
Ibrahim Sultan, Valentino Bianco, Ibrahim Yajzi, Arman Kilic, Keith Dufendach, Arturo Cardounel, Andrew D Althouse, Ahmad Masri, Forozan Navid, Thomas G Gleason
BACKGROUND: Deep hypothermic circulatory arrest (DHCA) is often avoided in patients with concomitant ascending aortic pathology when treating other cardiac disease to avoid increased risk of morbidity and mortality. We hypothesized that the use of DHCA with retrograde cerebral perfusion (RCP) does not add incremental risk to ascending aortic replacement alone in the setting of concomitant cardiac surgery. METHODS: 408 ascending aortic ± hemiarch replacements and aortic (root)/mitral/tricuspid valve(s), CABG, or MAZE procedures were performed for concomitant cardiac disease...
May 3, 2018: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/29707342/aortic-arch-repair-under-moderate-hypothermic-circulatory-arrest-with-or-without-antegrade-cerebral-perfusion-based-on-the-extent-of-repair
#5
Sung Jun Park, Bo Bae Jeon, Hee Jung Kim, Joon Bum Kim
Background: For aortic-arch repair, moderate hypothermic circulatory arrest (HCA) have shown favorable outcomes over conventional deep HCA when coupled with antegrade cerebral perfusion (ACP); however, recent studies have shown that ACP may not be essential when circulatory arrest time is less than 30 minutes. This study aims to evaluate the stratified arch repair strategy of moderate HCA with or without ACP based on the extent of procedure. Methods: Consecutive 138 patients (63 female; mean age, 60...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29707307/retrograde-perfusion-through-superior-vena-cava-reaches-the-brain-during-circulatory-arrest
#6
Mario Gaudino, Natalia Ivascu, Melissa Cushing, Christopher Lau, Ivancarmine Gambardella, Antonino Di Franco, Lucas B Ohmes, Monica Munjal, Leonard N Girardi
Background: The optimal technique for brain perfusion during circulatory arrest remains controversial. Concern exists that retrograde cerebral perfusion (RCP) via the superior vena cava (SVC) is unable to perfuse the brain. We evaluated whether RCP blood circulates through the brain parenchyma in humans during deep hypothermic circulatory arrest (DHCA). We hypothesized that a significant difference in the levels of S-100β (a protein with very high neuro-sensitivity) between the blood infused in the SVC and the effluent blood returning in the left carotid artery (CA) during RCP, should be regarded as a sign of the circulation of RCP blood through the brain parenchyma...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29699874/aortic-arch-reconstruction-are-hybrid-debranching-procedures-a-good-choice
#7
REVIEW
Nikolaos A Papakonstantinou, Constantine N Antonopoulos, Nikolaos G Baikoussis, Ioannis Kakisis, Georgios Geroulakos
INTRODUCTION: Conventional open total arch replacement is the treatment of choice for surgical aortic arch pathologies. However, it is an invasive procedure, requiring cardiopulmonary bypass and deep hypothermic circulatory arrest leading to significant morbidity and mortality rates. Hybrid aortic arch debranching procedures without (type I) or with (type II) ascending aorta replacement seek to limit operative, bypass, and circulatory arrest times by making the arch repair procedure simpler and shorter...
March 30, 2018: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29683812/current-trends-in-aortic-root-surgery-the-mini-bentall-approach
#8
Djamila Abjigitova, Georgia Panagopoulos, Oleg Orlov, Vishal Shah, Konstadinos A Plestis
OBJECTIVE: The mini-sternotomy approach is becoming a widespread technique for aortic valve surgery. However, its safety for aortic root replacement has yet to be established. The aim of the present study was to compare the operative outcomes of patients who underwent aortic root replacement via upper mini-sternotomy (mini-Bentall) to patients who underwent Bentall procedure via median sternotomy (full-sternotomy Bentall). METHODS: Between November 1998 and November 2016, 91 consecutive patients underwent full-sternotomy Bentall procedure and 26 patients underwent mini-Bentall procedure...
April 20, 2018: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
https://www.readbyqxmd.com/read/29682460/simple-retrograde-cerebral-perfusion-is-as-good-as-complex-antegrade-cerebral-perfusion-for-hemiarch-replacement
#9
Akiko Tanaka, Anthony L Estrera
Cerebral complication is a major concern after aortic arch surgery, which may lead to death. Thus, cerebral protection strategy plays the key role to obtain respectable results in aortic arch repair. Deep hypothermic circulatory arrest was introduced in 1970s to decrease the ischemic insults to the brain. However, safe duration of circulatory arrest time was limited to 30 minutes. The 1990s was the decade of evolution for cerebral protection, in which two adjuncts for deep hypothermic circulatory arrest were introduced: retrograde and antegrade cerebral perfusion (ACP) techniques...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29672688/distal-aortic-arch-aneurysm-in-an-adult-case-of-phace-syndrome
#10
Chiharu Tanaka, Shinichiro Shimura, Yasunori Cho, Toshihiko Ueda
A rare case of adult PHACE syndrome with a distal aortic arch aneurysm was treated surgically. The patient had several anomalies including uneven cerebral blood flow, a small left common carotid artery and a narrowed transverse aorta. Under deep hypothermic circulatory arrest, aortic replacement with reconstruction of the left subclavian artery was performed uneventfully. Cystic degeneration of the tunica media was observed in the aneurysm wall.
April 16, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29657946/too-cold-to-clot-does-intraoperative-hypothermia-contribute-to-bleeding-after-aortic-surgery
#11
Louis H Stein, Gregory Rubinfeld, Leora B Balsam, Patricia Ursomanno, Abe DeAnda
Background: We determined the impact of intraoperative hypothermia on postoperative bleeding after thoracic aortic surgery. Methods: We retrospectively analyzed 98 consecutive patients who underwent aortic surgery with deep hypothermic circulatory arrest between 2010 and 2014. We evaluated lowest temperature, absolute decrease in temperature, and rewarming rate. Univariate and multivariate regression were used to determine relationships between temperature, clinical characteristics, and measures of postoperative bleeding...
August 2017: Aorta (Stamford, Conn.)
https://www.readbyqxmd.com/read/29649955/repair-of-tevar-associated-type-a-dissection-in-the-elderly-is-possible-with-reasonable-morbidity-and-mortality
#12
Angela Kornberger, Risteski Petar, Hazem El Beyrouti, Mahmud Khalil, Iris Burck, Nancy Halloum, Andres Beiras-Fernandez, Christian-Friedrich Vahl
BACKGROUND: Type A aortic dissection (AAD) is a devastating complication of thoracic endovascular repair (TEVAR). In elderly patients, surgery for AAD carries considerable morbidity and mortality. Repair of AAD after previous TEVAR is an even greater challenge as it usually requires the arch to be addressed and a preexisting stent graft to be included into the aortic repair. METHODS: A case series of 5 elderly patients who presented with acute AAD after previous TEVAR was reviewed...
January 1, 2018: Vascular and Endovascular Surgery
https://www.readbyqxmd.com/read/29623838/mir-29-targets-puma-to-suppress-oxygen-and-glucose-deprivation-reperfusion-ogd-r-induced-cell-death-in-hippocampal-neurons
#13
Rong Wei, Rufang Zhang, Hongmei Li, Hongyun Li, Saiji Zhang, Yewei Xie, Shen Li, Fang Chen
We previously demonstrate that microRNAs (miRNA) play an important role in hypothermic circulatory arrest (DHCA)-associated neural injury. However, the specific role of miRNAs in the pathogenesis of DHCA-induced neuron death is still unclear. Thus, in the present study, we investigated miR-29 expression and roles in neuronal HT-22 cells with oxygen-glucose deprivation/reoxygenation (OGD/R). In this study, the model of OGD/R was established using an airtight culture container and the anaeropack. Measurement of reactive oxygen species (ROS) production and mitochondrial membrane potential (MMP) was used the probes of JC-1 and H2DCFDA...
April 3, 2018: Current Neurovascular Research
https://www.readbyqxmd.com/read/29615357/use-of-extracorporeal-bypass-is-associated-with-improved-outcomes-in-open-thoracic-and-thoracoabdominal-aortic-aneurysm-repair
#14
Jahan Mohebali, Stephanie Carvalho, R Todd Lancaster, Emel A Ergul, Mark F Conrad, W Darrin Clouse, Richard P Cambria, Virendra I Patel
OBJECTIVE: There is no consensus on the use or benefit of extracorporeal circulation (EC) during aneurysm repair of the descending thoracic aorta (DTA) or thoracoabdominal aorta (TAA). We evaluated the role of EC during DTA or TAA aneurysm repair using U.S. Medicare data. METHODS: Medicare (2004-2007) patients undergoing open repair of nonruptured DTA or TAA aneurysm were identified by International Classification of Diseases, Ninth Revision code. Specific exclusions included ascending aortic or arch repairs, concomitant cardiac procedures, and procedures employing deep hypothermic circulatory arrest...
March 31, 2018: Journal of Vascular Surgery
https://www.readbyqxmd.com/read/29596696/erratum-to-deep-hypothermic-circulatory-arrest-or-tepid-regional-cerebral-perfusion-impact-on-haemodynamics-and-myocardial-integrity-in-a-randomized-experimental-trial-interact-cardiovasc-thorac-surg-2018-26-667-672
#15
Stephanie Kellermann, Carina Janssen, Frank Münch, Adrian Koch, Regine Schneider-Stock, Robert Anton Cesnjevar, André Rüffer
No abstract text is available yet for this article.
April 1, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29590367/selective-visceral-perfusion-improves-renal-flow-and-hepatic-function-in-neonatal-aortic-arch-repair
#16
Joaquín Fernández-Doblas, Christian Ortega-Loubon, Joaquín Pérez-Andreu, Marcos Linés, Manuel Fernández-Molina, Raúl F Abella
OBJECTIVES: The aortic arch repair in the neonatal period is a complex procedure with significant morbidity. We define a useful double-perfusion technique and its effect on the function of abdominal organs in the postoperative course. METHODS: Nine patients with double perfusion (Group 1) were compared with 14 patients with antegrade cerebral perfusion (Group 2). The objective was to discern the incidence of postoperative acute kidney injury and impaired hepatic function, as well as tissue perfusion and myocardial function parameters...
March 26, 2018: Interactive Cardiovascular and Thoracic Surgery
https://www.readbyqxmd.com/read/29580655/protection-of-the-rat-brain-from-hypothermic-circulatory-arrest-injury-by-a-chipmunk-protein
#17
Xuan Jiang, Tianxiang Gu, Yu Liu, Chun Wang, Enyi Shi, Guangwei Zhang, Zongyi Xiu
OBJECTIVES: The study objectives were to test the hypothesis that special protein exists in hibernating chipmunk albumin and whether this protein has a neuroprotective effect in Sprague-Dawley rats during deep hypothermia circulatory arrest. METHODS: Forty chipmunks were allocated into a hibernation group and an active group (20 chipmunks in each group). Special protein was detected and isolated from hibernating chipmunk albumin. Forty Sprague-Dawley rats were randomly divided into a sham group, deep hypothermia circulatory arrest group, special protein group, and naloxone group (10 rats in each group)...
February 24, 2018: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/29571643/acute-kidney-injury-after-total-arch-replacement-combined-with-frozen-elephant-trunk-implantation-incidence-risk-factors-and-outcome
#18
Hui Zhou, Guyan Wang, Lijing Yang, Sheng Shi, Jun Li, Meng Wang, Congya Zhang, Hongyan Li, Xiangyang Qian, Xiaogang Sun, Qian Chang, Cuntao Yu
OBJECTIVES: Acute kidney injury (AKI) is common after thoracic aortic surgery and is a significant predictor of morbidity and mortality. Total arch replacement (TAR) combined with frozen elephant trunk (FET) implantation has been reported to produce satisfactory clinical outcomes, whereas several features of the surgical procedure may induce postoperative AKI. The authors aimed to clarify the incidence of and risk factors for postoperative AKI and the association of AKI with short-term outcomes...
February 15, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29552520/video-assisted-right-mini-thoracotomy-for-aortic-root-replacement
#19
Carl A Johnson, Katherine L Wood, Amber L Melvin, Brandon F Lebow, Peter A Knight
Aortic root replacement is typically performed through a median sternotomy. The right anterior mini-thoracotomy approach has been shown to decrease hospital length of stay in aortic valve surgery when compared to sternotomy. This approach is rare in ascending aortic surgery due to technical challenges which include exposure and annular suture placement. Automated suturing technology is now available to facilitate the placement of annular sutures. The use of a camera greatly enhances visualization of the aortic root...
2018: Journal of Visualized Surgery
https://www.readbyqxmd.com/read/29532651/an-innovative-arch-first-surgical-procedure-under-moderate-hypothermia-for-acute-type-a-aortic-dissection
#20
Kangjun Shen, Xinmin Zhou, Ling Tan, Feng Li, Jun Xiao, Hao Tang
BACKGROUND: We hypothesized that the arch-first procedure without extra devices under moderate-to-mild systemic hypothermia during acute type A aortic dissection is safe and efficient and will improve patient outcome compared with the standard total arch replacement technique. METHODS: From December 2014 to February 2017, 89 patients were enrolled in this study, 52 of whom underwent conventional deep hypothermic circulatory arrest (DHCA, 24.2 ± 0.71°C) using the antegrade cerebral perfusion surgical procedure (Group A) and 37 of whom underwent the "arch-first" technique with moderate (27...
March 12, 2018: Journal of Cardiovascular Surgery
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