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Integrated cerebral perfusion for hypothermic circulatory arrest during transverse aortic arch repairs.
MedLine Citation:
PMID:  20304662     Owner:  NLM     Status:  In-Process    
Abstract/OtherAbstract:
OBJECTIVES: Antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) for ascending/transverse arch repair is used for cerebral protection. This study evaluates ACP in combination with retrograde cerebral perfusion (RCP) during extended HCA and compares it to RCP-only.
METHODS: Between January 2005 and April 2007, we performed 64 consecutive arch repairs requiring extended HCA (>40 min). RCP-only was used with 34 patients and ACP with brief RCP ('integrated') was used with 30 patients. Mean HCA time was 51 + or - 13 min. Mean RCP-only time was 47 + or - 9.6 min; in the integrated group, mean ACP time was 42 + or - 14.4 min with an added RCP time of 10.8 + or - 7.6 min. For the entire cohort, 95% (61/64) underwent total arch repair, and 67% (43/64) had elephant trunk reconstruction. Variables predictive of mortality and neurological outcomes were analysed prospectively, but technique selection was non-randomised.
RESULTS: Preoperative and operative variables did not differ between the RCP-only and the integrated groups except for aortic valve replacement, which was more frequently performed in the integrated group (33% (10/30) vs 12% (4/34), P=0.05), and preoperative renal dysfunction, which was more frequent in the RCP group (26% (9/34) vs 7% (2/30), P=0.04). No significant difference was observed in outcomes between the groups; however, the integrated group had higher mortality, stroke and temporary neurological deficit than RCP-only.
CONCLUSIONS: The observed trends in actual outcomes were a cause for concern. ACP combined with a short period of RCP did not provide better outcomes than RCP-only. The use of RCP remains warranted in our experience.
Authors:
Anthony L Estrera; Charles C Miller; Taek-Yeon Lee; Pallav Shah; Adel D Irani; Nidal Ganim; Saad Abdullah; Hazim J Safi
Publication Detail:
Type:  Journal Article     Date:  2010-03-20
Journal Detail:
Title:  European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery     Volume:  38     ISSN:  1873-734X     ISO Abbreviation:  Eur J Cardiothorac Surg     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-23     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8804069     Medline TA:  Eur J Cardiothorac Surg     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  293-8     Citation Subset:  IM    
Copyright Information:
Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Affiliation:
Department of Cardiothoracic and Vascular Surgery, The University of Texas at Houston Medical School, Memorial Hermann Heart and Vascular Institute, Houston, TX, USA. anthony.l.estrera@uth.tmc.edu
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