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Wang YP, Lu LC, Li SC, Li L, Jiang Y, Cheng YQ, Ge M, Chen Y, Wang DJ. "Drum Tower Hospital" strategy for acute type A aortic dissection with coma. Perfusion 2023:2676591231210459. [PMID: 37885091 DOI: 10.1177/02676591231210459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OVERVIEW Acute type A aortic dissection (ATAAD) with persistent coma is a life-threatening condition associated with high mortality and poor neurological outcomes. The optimal timing for surgical intervention in these patients remains uncertain, and many patients are not eligible for surgery due to their poor prognosis. DESCRIPTION In this case, a 53-year-old man with hypertension presented to the emergency department in a coma that had lasted for 9 hours. The patient was diagnosed with ATAAD and underwent the "Drum Tower Hospital" strategy, which involved preoperative assessments, including computed tomography angiography (CTA) and quantitative electroencephalogram (qEEG) monitoring. Surgical interventions, such as emergency stenting and aortic replacement, were performed to restore blood flow and repair the aorta. Postoperative monitoring, including qEEG, showed improvements in brain function. Despite the patient experiencing hemiplegia and a neurological deficit, the "Drum Tower Hospital" strategy, guided by comprehensive brain assessments, showed promise in managing ATAAD with coma. However, further research is needed to establish effective treatment strategies for these patients. Overall, ATAAD with persistent coma is a critical condition with limited treatment options. The "Drum Tower Hospital" strategy, supported by multimodal brain assessment, offers a potential approach to improve outcomes in these patients.
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Affiliation(s)
- Ya-Peng Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Li-Chong Lu
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Shu-Chun Li
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Li Li
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yi Jiang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
| | - Yong-Qing Cheng
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Min Ge
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yang Chen
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Dong-Jin Wang
- Department of Cardio-Thoracic Surgery, Nanjing Drum Tower Hospital, Peking Union Medical College Graduate School, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China
- Department of Cardiothoracic Surgery, The Affiliated Hospital of Nanjing University Medical School, Nanjing Drum Tower Hospital, Nanjing, China
- Institute of Cardiothoracic Vascular Disease, Nanjing University, Nanjing, China
- Department of Cardio- Thoracic Surgery, Nanjing Drum Tower Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
- Nanjing Drum Tower Hospital, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Montisci A, Maj G, Cavozza C, Audo A, Benussi S, Rosati F, Cattaneo S, Di Bacco L, Pappalardo F. Cerebral Perfusion and Neuromonitoring during Complex Aortic Arch Surgery: A Narrative Review. J Clin Med 2023; 12:jcm12103470. [PMID: 37240576 DOI: 10.3390/jcm12103470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/14/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
Complex ascending and aortic arch surgery requires the implementation of different cerebral protection strategies to avoid or limit the probability of intraoperative brain damage during circulatory arrest. The etiology of the damage is multifactorial, involving cerebral embolism, hypoperfusion, hypoxia and inflammatory response. These protective strategies include the use of deep or moderate hypothermia to reduce the cerebral oxygen consumption, allowing the toleration of a variable period of absence of cerebral blood flow, and the use of different cerebral perfusion techniques, both anterograde and retrograde, on top of hypothermia, to avoid any period of intraoperative brain ischemia. In this narrative review, the pathophysiology of cerebral damage during aortic surgery is described. The different options for brain protection, including hypothermia, anterograde or retrograde cerebral perfusion, are also analyzed, with a critical review of the advantages and limitations under a technical point of view. Finally, the current systems of intraoperative brain monitoring are also discussed.
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Affiliation(s)
- Andrea Montisci
- Division of Cardiothoracic Intensive Care, Cardiothoracic Department, ASST Spedali Civili, 25123 Brescia, Italy
| | - Giulia Maj
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, AO SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Corrado Cavozza
- Department of Cardiac Surgery, AO SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Andrea Audo
- Department of Cardiac Surgery, AO SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Stefano Benussi
- Division of Cardiac Surgery, Cardiothoracic Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
| | - Fabrizio Rosati
- Division of Cardiac Surgery, Cardiothoracic Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
| | - Sergio Cattaneo
- Division of Cardiothoracic Intensive Care, Cardiothoracic Department, ASST Spedali Civili, 25123 Brescia, Italy
| | - Lorenzo Di Bacco
- Division of Cardiac Surgery, Cardiothoracic Department, ASST Spedali Civili and University of Brescia, 25123 Brescia, Italy
| | - Federico Pappalardo
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, AO SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
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Song Y, Liu L, Jiang B, Wang Y. Analysis of risk factors of cerebral complications after Stanford type A aortic dissection involving arch surgery. Asian J Surg 2021; 45:456-460. [PMID: 34376364 DOI: 10.1016/j.asjsur.2021.07.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the risk factors of cerebral neurological complications after surgery for Stanford type A aortic arch surgery. METHODS One hundred sixteen patients who received Stanford type A aortic dissection from January 2012 to December 2019 were recruited. All patients received surgery under deep hypothermic circulatory arrest (DHCA) and general anesthesia. They were grouped by degree of postoperative cerebral neurological complication. The related factors of cerebral neurological complications were analyzed by single-factor analysis and multi-factor logistic regression. RESULTS Postoperative neurological complications were observed in 31 cases (26.72 %). Two groups were identified: permanent neurological dysfunction (PND) was observed in seven cases, and temporary neurological dysfunction (TND) was observed in 24 cases. In-hospital mortality was 9.48 % (11/116), with six in the cerebral complication groups and five in the non-complication group. Single-factor analysis showed the associated factors were age, stroke history, carotid plaque or stenosis, emergency surgery, renal dysfunction, hypotension, aortic clamping time, deep hypothermic circulatory arrest time, postoperative hypoxemia, postoperative low cardiac output and plasma transfusion >800 ml, and erythrocyte suspension transfusion >6 U. Multi-factor logistic analysis showed the independent predictive factors were DHCA time >40 min, plasma transfusion >800 ml, erythrocyte suspension transfusion >6 U, history of stroke, and carotid plaque or stenosis. CONCLUSION The factors independently associated with neurological complications are DHCA time >40 min, plasma transfusion >800 ml, erythrocyte suspension transfusion >6 U, history of stroke, and carotid plaque or stenosis. Our findings suggest that patients with these risk factors should receive intervention during treatment to reduce cerebral neurological complications.
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Affiliation(s)
- Yanyan Song
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Li Liu
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Bo Jiang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China
| | - Yun Wang
- Department of Cardiovascular Surgery, General Hospital of Ningxia Medical University, Yinchuan, China.
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Detter C, Demal TJ, Bax L, Tsilimparis N, Kölbel T, von Kodolitsch Y, Vettorazzi E, Reichenspurner H, Brickwedel J. Simplified frozen elephant trunk technique for combined open and endovascular treatment of extensive aortic diseases. Eur J Cardiothorac Surg 2019; 56:738-745. [DOI: 10.1093/ejcts/ezz082] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
OBJECTIVES:
This study aims to analyse the impact of a simplified frozen elephant trunk (FET) technique on early outcome.
METHODS:
Between October 2010 and August 2018, 92 consecutive patients (mean age 64.4 ± 12.2 years) underwent FET surgery. Underlying pathologies were thoracic aneurysm in 35 patients, acute aortic dissection in 25 patients and chronic dissection in 32 patients. Thirty patients underwent a simplified FET technique with deployment of the stent graft in arch zone 2 with an extra-anatomic bypass to the distal left subclavian artery using the third branch of the Thoraflex™ Hybrid Plexus prosthesis via a supraclavicular access during reperfusion. These patients were compared to 62 patients who received the conventional FET procedure, in which a distal anastomosis is performed in arch zone 3.
RESULTS:
Circulatory arrest (41.7 ± 10.5 vs 76.5 ± 33.0 min; P < 0.001) and antegrade cerebral perfusion times (60.9 ± 13.5 vs 92.1 ± 33.1 min; P < 0.001) were significantly reduced in zone 2 vs zone 3 patients, respectively. The 30-day mortality rate was 3.3% (n = 1) in zone 2 patients vs 17.7% (n = 11) in zone 3 patients (P = 0.75). Stent deployment in zone 2 was associated with significantly reduced rates of postoperative stroke [zone 2: n = 0 (0.0%); zone 3: n = 11 (17.7%), P = 0.046] and recurrent nerve palsy [zone 2: n = 1 (3.3%); zone 3: n = 14 (22.6%), P = 0.020).
CONCLUSIONS:
Simplifying the FET procedure leads to reduced circulatory arrest and cerebral perfusion times and improves early outcome.
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Affiliation(s)
- Christian Detter
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Till Joscha Demal
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Lennart Bax
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Nikolaos Tsilimparis
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Yskert von Kodolitsch
- Department of General and Interventional Cardiology, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Eik Vettorazzi
- Department of Medical Biometry and Epidemiology, University Hospital Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Jens Brickwedel
- Department of Cardiovascular Surgery, German Aortic Center Hamburg, University Heart Center Hamburg, Hamburg, Germany
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Organprotektion in der Chirurgie der thorakalen Aorta. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2015. [DOI: 10.1007/s00398-015-0030-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Conway BD, Stamou SC, Kouchoukos NT, Lobdell KW, Khabbaz KR, Murphy E, Hagberg RC. Improved clinical outcomes and survival following repair of acute type A aortic dissection in the current era. Interact Cardiovasc Thorac Surg 2014; 19:971-6. [DOI: 10.1093/icvts/ivu268] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Rimmer L, Fok M, Bashir M. The History of Deep Hypothermic Circulatory Arrest in Thoracic Aortic Surgery. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2014; 2:129-34. [PMID: 26798730 DOI: 10.12945/j.aorta.2014.13-049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 04/10/2014] [Indexed: 11/18/2022]
Abstract
Depending on the extent of aortic disease and surgical repair required, thoracic aortic surgery often involves periods of reduced cerebral perfusion. Historically, this resulted in detrimental neurological dysfunction, and high risk of mortality and morbidity. Over the last half century, rapid improvements have revolutionized aortic surgery. Among these, deep hypothermic circulatory arrest (DHCA) has drastically reduced the risk of mortality and morbidity following surgery on the thoracic aorta. This progress was facilitated by experimental pioneers such as Bigelow, who studied reduced oxygen expenditure consequent on induction of hypothermia in dogs. These encouraging findings led to trials in human cardiac surgery by Lewis in 1952 and further made possible the first successful aortic arch replacement by Denton Cooley and Michael De Bakey. Modern day surgery has come a long way from the use of immersion of the patient in ice baths and other primitive techniques previously described. This paper explores the development of deep hypothermic circulatory arrest from its origins to the present.
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Affiliation(s)
- Lara Rimmer
- Thoracic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Matthew Fok
- Thoracic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mohamad Bashir
- Thoracic Aneurysm Service, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
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Di Natale M, Tancredi F, Bachicchio V, Paternoster G, Lentini S. EndoClamp Aortic Catheter in the descending aorta for normothermic aortic arch replacement on the beating heart without circulatory arrest. Perfusion 2013; 28:453-6. [DOI: 10.1177/0267659113486509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- M Di Natale
- Cardiac Surgery Unit, Ospedale San Carlo, Potenza, Italy
| | - F Tancredi
- Cardiac Surgery Unit, Ospedale San Carlo, Potenza, Italy
| | - V Bachicchio
- Cardiac Surgery Unit, Ospedale San Carlo, Potenza, Italy
| | - G Paternoster
- Cardiac Surgery Unit, Ospedale San Carlo, Potenza, Italy
| | - S Lentini
- Department of Cardiovascular Surgery, Città di Lecce Hospital, GVM Care & Research, Lecce, Italy
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Krüger T, Hoffmann I, Blettner M, Borger MA, Schlensak C, Weigang E. Intraoperative neuroprotective drugs without beneficial effects? Results of the German Registry for Acute Aortic Dissection Type A (GERAADA). Eur J Cardiothorac Surg 2013; 44:939-46. [DOI: 10.1093/ejcts/ezt182] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Tobias Krüger
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Isabell Hoffmann
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Maria Blettner
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | | | - Christian Schlensak
- Department of Thoracic, Cardiac and Vascular Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Ernst Weigang
- Department of Cardiothoracic and Vascular Surgery, Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
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Fernandes P, Cleland A, Adams C, Chu MWA. Clinical and biochemical outcomes for additive mesenteric and lower body perfusion during hypothermic circulatory arrest for complex total aortic arch replacement surgery. Perfusion 2012; 27:493-501. [DOI: 10.1177/0267659112453753] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Surgical repair of transverse aortic arch aneurysms frequently employ hypothermia and antegrade cerebral perfusion as protective strategies during circulatory arrest. However, prolonged mesenteric and lower limb ischemia can lead to significant lactic acidosis and end organ dysfunction, which remains a significant cause of post-operative morbidity and mortality. We report our experience with additive warm mesenteric and lower body perfusion (1-3 L/min, 30°C) in addition to continuous cerebral and myocardial perfusion in 5 patients who underwent total aortic arch replacement with trifurcated head vessel re-implantation and distal elephant trunk reconstruction. Concomitant surgical procedures included re-operations (2), aortic root operations (2), coronary artery bypass (2) and descending thoracic aortic replacement (1). Serum lactate levels demonstrated a rapid decline from a peak 9.9±2.6 post circulatory arrest to 3.4±2.0 in the intensive care unit (ICU). The lowest serum bicarbonate levels were 19.3±3.5 mmol/L, intra-operatively, which normalized to 28.4±2.4 mmol/L on return to the ICU. The lowest pH levels were 7.25±0.10, corrected to 7.43±0.04 on return to the ICU. Mean cardiopulmonary bypass and aortic cross-clamp times were 361±104 and 253±85 minutes, respectively. Mean cerebral and lower body circulatory arrest times were 0 (0) and 50±35 minutes, respectively. The mean time required for systemic rewarming was 95±66 minutes. There were no in-hospital mortalities and no patient experienced any neurological, mesenteric, renal or lower limb ischemic complications. Two patients required mechanical ventilation >24 hours, and one patient returned for reoperation for bleeding. Median intensive care unit and total hospital lengths of stay were 5 and 16 days, respectively. Our results suggest early serum lactate clearance, normalization of acidosis, and metabolic recovery when utilizing a simultaneous cerebral perfusion and warm body protection strategy for complex aortic arch surgery. This additive perfusion strategy may attenuate visceral and lower body ischemia that normally develops during periods of deep hypothermic circulatory arrest.
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Affiliation(s)
- P Fernandes
- Clinical Perfusion Services, Cardiac Care, University of Western Ontario, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - A Cleland
- Clinical Perfusion Services, Cardiac Care, University of Western Ontario, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - C Adams
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
| | - MWA Chu
- Division of Cardiac Surgery, Department of Surgery, University of Western Ontario, Lawson Health Research Institute, London Health Sciences Centre, London, Ontario, Canada
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Salah K, van Straten AHM, Soliman Hamad MA, ter Woorst JF, Tan MESH. Evolution of cerebral perfusion techniques in type a aortic dissection surgery: a single center experience. Perfusion 2012; 27:363-70. [PMID: 22611026 DOI: 10.1177/0267659112448411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the effect of using antegrade selective cerebral perfusion (ASCP) with moderate hypothermia on hospital mortality after surgery for acute type A aortic dissection (AAAD). METHODS Between January 1998 and December 2008, 142 consecutive patients were operated on for AAAD. Patients were divided into two subgroups: the cohort of patients operated on from January 1998 until December 2003 (without ASCP) (P1998-2003, n=64) and the cohort operated on from January 2004 until December 2008 (with ASCP)(P2004-2008, n=78). RESULTS The difference in hospital mortality was statistically significant (P1998-2003: 42.2%; P2004-2008: 14.1%, p<0.0005). Survival rates were 51.6±6.2% vs. 75.1±5.5% and 45.9±6.2% vs. 69.7±7.3% for one and four years, respectively (p=0.001). Multivariate logistic regression analysis revealed that ASCP was the only independent protective factor of hospital mortality (p=0.047). CONCLUSION In patients operated on for AAAD, antegrade selective cerebral perfusion with moderate hypothermia is a significant factor in decreasing hospital mortality.
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Affiliation(s)
- K Salah
- Department of Cardiothoracic Surgery, Catharina Hospital, Eindhoven, The Netherlands
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