Document Detail


Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life.
MedLine Citation:
PMID:  18442549     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: We have shown that selective antegrade cerebral perfusion improves mid-term quality of life in patients undergoing surgical repair for acute type A aortic dissection and aortic aneurysms. The aim of the study was to assess the impact of continuous cerebral perfusion through the right subclavian artery on immediate outcome and quality of life. METHODS: Perioperative data of 567 consecutive patients who underwent surgery of the aortic arch using deep hypothermic circulatory arrest have been analyzed. Patients were divided into three groups, according to the management of cerebral protection. Three hundred eighty-seven patients (68.3%) had deep hypothermic circulatory arrest with pharmacologic protection with pentothal only, 91 (16.0%) had selective antegrade cerebral perfusion and pentothal, and 89 (15.7%) had continuous cerebral perfusion through the right subclavian artery and pentothal. All in-hospital data were assessed, and quality of life was analyzed prospectively 2.4 +/- 1.2 years after surgery with the Short Form-36 Health Survey Questionnaire. RESULTS: Major perioperative cerebrovascular injuries were observed in 1.1% of the patients with continuous cerebral perfusion through the right subclavian artery, compared with 9.8% with selective antegrade cerebral perfusion (p < 0.001) and 6.5% in the group with no antegrade cerebral perfusion (p = 0.007). Average quality of life after an arrest time between 30 and 50 minutes with continuous cerebral perfusion through the right subclavian artery was significantly better than selective antegrade cerebral perfusion (90.2 +/- 12.1 versus 74.4 +/- 40.7; p = 0.015). CONCLUSIONS: Continuous cerebral perfusion through the right subclavian artery improves considerably perioperative brain protection during deep hypothermic circulatory arrest. Irreversible perioperative neurologic complications can be significantly reduced and duration of deep hypothermic circulatory arrest can be extended up to 50 minutes without impairment in quality of life.
Authors:
Franz F Immer; Barbara Moser; Eva S Krähenbühl; Lars Englberger; Mario Stalder; Friedrich S Eckstein; Thierry Carrel
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  85     ISSN:  1552-6259     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-04-29     Completed Date:  2008-05-15     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1614-8; discussion 1618     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland. franzimmer@yahoo.de
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MeSH Terms
Descriptor/Qualifier:
Activities of Daily Living
Aged
Aneurysm, Dissecting / surgery*
Angioplasty*
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / surgery*
Arm / innervation
Brachial Plexus Neuropathies / diagnosis,  etiology*
Brain / blood supply*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Neurologic Examination
Perfusion
Postoperative Complications / diagnosis,  etiology*
Prospective Studies
Quality of Life*
Subclavian Artery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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