Document Detail

The methodologies of hypothermic circulatory arrest and of antegrade and retrograde cerebral perfusion for aortic arch surgery.
MedLine Citation:
PMID:  18577891     Owner:  NLM     Status:  MEDLINE    
In spite of recent advances in thoracic aortic surgery, postoperative neurological injury still remains the main cause of mortality and morbidity after aortic arch operation. The use of cardiopulmonary bypass (CPB) and hypothermic circulatory arrest, temporary interruption of brain circulation, transient cerebral hypoperfusion, and manipulations on the frequently atheromatic aorta all produce neurological damages. The basic established techniques and perfusion strategies during aortic arch replacement number three: hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP), and retrograde cerebral perfusion (RCP). During the past decade and after several experimental studies, RCP lost its previous place in the armamentarium of brain protection, giving it up to ACP as a major method of brain perfusion during HCA. HCA should be applied at a temperature of asymptotically equal to 20 degrees C with long-lasting cooling and rewarming and should not exceed by itself the time of 20-25 min. RCP does not seem to prolong safe brain-ischemia time beyond 30 min, but it appears to enhance cerebral hypothermia by its massive concentration inside the brain vein sinuses. HCA combined with ACP, however, could prolong safe brain-ischemia time up to 80 min. Cold ACP at 10 degrees -13 degrees C should be initially applied through the right subclavian or axillary artery and continued bihemispherically through the left common carotid artery at first and later the anastomosed graft, with a mean perfusion pressure of 40-70 mm Hg. The safety of temporary perfusion is being confirmed by the meticulous monitoring of brain perfusion through internal jugular bulb O2 saturation, electroencephalogram, and transcranial comparative Doppler velocity of the middle cerebral arteries.
Efstratios Apostolakis; Karolina Akinosoglou
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia     Volume:  14     ISSN:  1341-1098     ISO Abbreviation:  Ann Thorac Cardiovasc Surg     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-25     Completed Date:  2008-08-15     Revised Date:  2009-09-18    
Medline Journal Info:
Nlm Unique ID:  9703158     Medline TA:  Ann Thorac Cardiovasc Surg     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  138-48     Citation Subset:  IM    
Cardiothoracic Surgery-Clinic, University Hospital of Patras, Rio, Greece.
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MeSH Terms
Anastomosis, Surgical
Aorta, Thoracic / surgery*
Aortic Diseases / physiopathology,  surgery*
Blood Vessel Prosthesis Implantation* / adverse effects
Cerebrovascular Circulation*
Circulatory Arrest, Deep Hypothermia Induced*
Practice Guidelines as Topic
Comment In:
Ann Thorac Cardiovasc Surg. 2009 Aug;15(4):272-3; author reply 273-4   [PMID:  19763063 ]

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