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Kubota H, Endo H, Noma M, Ishii H, Tsuchiya H, Yoshimoto A, Takahashi Y, Inaba Y, Nishino Y, Nunokawa M, Hosoi Y, Ikezoe T, Nemoto M, Makino Y, Nemoto Y, Matsukura M, Sugiyama M, Abe N, Takeuchi H, Nagao G, Kondo E, Yanagida O, Yoshino H, Sudo K. Xenopericardial roll graft replacement for infectious pseudoaneurysms and graft infections of the aorta. J Cardiothorac Surg 2015; 10:133. [PMID: 26506850 PMCID: PMC4624649 DOI: 10.1186/s13019-015-0343-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 10/26/2015] [Indexed: 11/29/2022] Open
Abstract
Background Which graft material is the optimal graft material for the treatment of infected aortic aneurysms and aortic graft infections is still a matter of controversy. Orthotopic aortic reconstruction with intraoperatively prepared xenopericardial roll grafts without omentopexy was performed as the “initial” operation to treat aortic infection or as a “rescue” operation to treat graft infection. Mid-term outcomes were evaluated. Methods Between 2009 and 2013, orthotopic xenopericardial roll graft replacement was performed to treat eight patients (male/female: 6/2; mean age: 69.5 [55–80] yr). Graft material: equine/bovine pericardium: 2/6; type of operation: initial 4/rescue 4; omentopexy 0. Additional operation: esophagectomy 2. Mean follow-up period: 2.6 ± 1.6 (1.1–5.1) years. Results Replacement: ascending 3, arch 1 (reconstruction of neck vessels with small xenopericardial roll grafts), descending 3, and thoracoabdominal 1. Pathogens: MRSA 2, MSSA 1, Candida 1, E. coli 1, oral bacillus 1, and culture negative 2. Postoperative local recurrence of infection: 0. Graft-related complications: stenosis 0, calcification 0, non-infectious pseudoaneurysm of anastomosis 2 (surgical repair: 1/TEVAR 1). In-hospital mortality: 2 (MOF: initial 1/rescue 1); Survival rate exclusive of in-hospital deaths (~3 y): 100 %, but one patient died of lung cancer (3.6 yr). Conclusions Because xenopericardial roll grafts are not composed of synthetic material, the replacement procedure is simpler and less invasive than the standard procedure. Based on the favorable results obtained, this procedure may have the possibility to serve as an option for the treatment of aortic infections and aortic graft infections not only as a “rescue” treatment but as an “initial” treatment as well. Electronic supplementary material The online version of this article (doi:10.1186/s13019-015-0343-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Hidehito Endo
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Mio Noma
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hikaru Ishii
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroshi Tsuchiya
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Akihiro Yoshimoto
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yu Takahashi
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yusuke Inaba
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yoshifumi Nishino
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masao Nunokawa
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yutaka Hosoi
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Tooru Ikezoe
- Department of Cardiovascular Surgery, Kyorin University, 6-20-2, Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masaru Nemoto
- Department of Vascular Surgery, Tokyo University, Tokyo, Japan
| | | | - Yoko Nemoto
- Department of Vascular Surgery, Tokyo University, Tokyo, Japan
| | | | - Masanori Sugiyama
- Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan
| | - Hirohisa Takeuchi
- Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan
| | - Gen Nagao
- Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan
| | - Eri Kondo
- Department of Gastroenterological Surgery, Kyorin University, Tokyo, Japan
| | - Osamu Yanagida
- Kosei General Hospital affiliated to Rissho Kosei-Kai, Tokyo, Japan
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Endo H, Kubota H, Tsuchiya H, Yoshimoto A, Takahashi Y, Inaba Y, Sudo K. Clinical efficacy of intermittent pressure augmented-retrograde cerebral perfusion. J Thorac Cardiovasc Surg 2012; 145:768-73. [PMID: 22498084 DOI: 10.1016/j.jtcvs.2012.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 01/27/2012] [Accepted: 03/12/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE During aortic surgery under hypothermic circulatory arrest, retrograde cerebral perfusion (RCP) is commonly used as a cerebroprotective method to extend the duration of circulatory arrest safely. Kitahori and colleagues described a novel protocol of RCP using intermittent pressure augmented (IPA)-RCP in 2005. The aim of the present study was to determine the clinical effectiveness of this novel protocol. METHODS A total of 20 consecutive patients undergoing total replacement of the aortic arch were assigned to a conventional RCP (n = 10) or an IPA-RCP group (n = 10). Cerebral perfusion was provided at a continuous venous pressure of 25 mm Hg in the conventional RCP, and venous pressure was intermittently provided at 20 mm Hg for 120 seconds and at 45 mm Hg for 30 seconds in the IPA-RCP group. The clinical outcomes were compared between the 2 groups. Regional cerebral oxygen saturation (rSO(2)) was measured using near infrared spectroscopy every 10 minutes from the beginning of RCP initiation. To represent the brain oxygen consumption, the decline ratio of rSO(2) was calculated. RESULTS There was no surgical mortality or major neurologic complications in either group. The interval from the end of surgery to full wakefulness was significantly shorter in the IPA-RCP group (85 ± 64 minutes) than in the conventional RCP group (310 ± 282 minutes; P < .05). Although the initial rSO(2) value did not show significant difference in both groups, the rSO(2) with IPA-RCP was greater than that with conventional RCP from 10 to 70 minutes (P < .05). The decline ratio of rSO(2) was lower in the IPA-RCP group than in the RCP perfusion group at all points (P < .05). CONCLUSIONS IPA-RCP might provide more homogenous cerebral perfusion and a more effective oxygen supply to the brain with better clinical results than conventional RCP.
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Affiliation(s)
- Hidehito Endo
- Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan.
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Kubota H, Takamoto S, Yoshino H, Kitahori K, Kawata M, Tonari K, Endo H, Tsuchiya H, Inaba Y, Takahashi Y, Sudo K. Clinical application of intermittent pressure-augmented retrograde cerebral perfusion. Ann Thorac Surg 2010; 90:1340-3. [PMID: 20868841 DOI: 10.1016/j.athoracsur.2010.03.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 01/08/2010] [Accepted: 03/16/2010] [Indexed: 11/24/2022]
Abstract
Brain protection is important during aortic arch surgery, especially in patients with cerebral ischemia. We clinically applied the effectiveness of a novel protocol of retrograde cerebral perfusion with intermittent pressure augmentation for brain protection in a canine model, as described in a previous report. Although, in our patient the brachiocephalic artery and left subclavian artery were occluded as a result of aortitis, there was a history of right cerebral infarction, recovery of consciousness, and no neurologic sequelae. Near-infrared oximetry showed recovery of intracranial blood oxygen saturation every time the pressure was augmented.
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Affiliation(s)
- Hiroshi Kubota
- Department of Cardiovascular Surgery, Kyorin University, Tokyo, Japan.
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Apostolakis E, Koletsis EN, Dedeilias P, Kokotsakis JN, Sakellaropoulos G, Psevdi A, Bolos K, Dougenis D. Antegrade versus retrograde cerebral perfusion in relation to postoperative complications following aortic arch surgery for acute aortic dissection type A. J Card Surg 2008; 23:480-7. [PMID: 18462340 DOI: 10.1111/j.1540-8191.2008.00587.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Aortic arch surgery is impossible without the temporary interruption of brain perfusion and therefore is associated with high incidence of neurologic injury. The deep hypothermic circulatory arrest (HCA), in combination with antegrade or retrograde cerebral perfusion (RCP), is a well-established method of brain protection in aortic arch surgery. In this retrospective study, we compare the two methods of brain perfusion. MATERIALS AND METHODS From 1998 to 2006, 48 consecutive patients were urgently operated for acute type A aortic dissection and underwent arch replacement under deep hypothermic circulatory arrest (DHCA). All distal anastomoses were performed with open aorta, and the arch was replaced totally in 15 cases and partially in the remaining 33 cases. Our patient cohort is divided into those protected with antegrade cerebral perfusion (ACP) (group A, n = 23) and those protected with RCP (group B, n = 25). RESULTS No significant difference was found between groups A and B with respect to cardiopulmonary bypass-time, brain-ischemia time, cerebral-perfusion time, permanent neurologic dysfunction, and mortality. The incidence of temporary neurologic dysfunction was 16.0% for group A and 43.50% for group B (p = 0.04). The mean extubation time was 3.39 +/- 1.40 days for group A and 4.96 +/- 1.83 days for group B (p = 0.0018). The mean ICU-stay was 4.4 +/- 2.3 days for group A and 6.9 +/- 2.84 days for group B (p = 0.0017). The hospital-stay was 14.38 +/- 4.06 days for group A and 19.65 +/- 6.91 days for group B (p = 0.0026). CONCLUSION The antegrade perfusion seems to be related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization, and hence lower total cost.
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