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Wang Y, Qu JZ, Wang D. Quantitative Electroencephalography Monitoring in Type A Aortic Dissection Surgery: A Clinical Case Review and Prospective Applications. Brain Behav 2024; 14:e70086. [PMID: 39378288 PMCID: PMC11460606 DOI: 10.1002/brb3.70086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 09/05/2024] [Accepted: 09/14/2024] [Indexed: 10/10/2024] Open
Abstract
PURPOSE This review explores advanced methods for assessing perioperative cerebral function in Type A aortic dissection (TAAD) patients, with a focus on quantitative electroencephalography (QEEG). It highlights the critical issue of cerebral malperfusion, which is associated with higher mortality and poor prognosis during the perioperative phase in TAAD patients. METHOD The review centers on the utilization of QEEG as a pivotal tool for the extensive monitoring of brain function at various stages: preoperatively, intraoperatively, and postoperatively. It elaborates on the foundational principles of QEEG, including the mathematical and computational analysis of electroencephalographic signals, enriched with intuitive graphical representations of cerebral functional states. FINDING QEEG is presented as an innovative approach for the real-time, noninvasive, and reliable assessment of cerebral function. The review details the application of QEEG in monitoring conditions such as preoperative cerebral malperfusion, intraoperative deep hypothermic circulatory arrest, and postoperative recovery of cerebral function in patients undergoing TAAD treatment. CONCLUSION Although QEEG is still in an exploratory phase for TAAD patients, it has shown efficacy in other domains, suggesting its potential in multimodal brain function monitoring. However, its broader application requires further research and technological advancements.
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Affiliation(s)
- Ya‐Peng Wang
- Department of Cardiothoracic SurgeryNanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeNanjingJiangsuChina
| | - Jason Z. Qu
- Department of Anesthesia, Critical Care and Pain MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Dong‐Jin Wang
- Department of Cardiothoracic SurgeryNanjing Drum Tower Hospital, Chinese Academy of Medical Sciences & Peking Union Medical CollegeNanjingJiangsuChina
- Department of Cardiothoracic SurgeryNanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical SchoolNanjingJiangsuChina
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He K, Qin X, Li M, Bian L, Yue H, Liang W, Wu Z. Two surgical strategies (early carotid reperfusion vs. Central aortic repair-first) of acute type a aortic dissection complicated with cerebral malperfusion syndrome: a meta-analysis and systematic review. BMC Cardiovasc Disord 2024; 24:239. [PMID: 38714966 PMCID: PMC11075335 DOI: 10.1186/s12872-024-03910-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE Cerebral malperfusion (CM) is a common comorbidity in acute type A aortic dissection (ATAAD), which is associated with high mortality and poor neurological prognosis. This meta-analysis investigated the surgical strategy of ATAAD patients with CM, aiming to compare the difference in therapeutic effectiveness between the central repair-first and the early reperfusion-first according to clinical outcomes. METHODS The meta-analysis and systematic review was conducted based on studies sourced from the PubMed, Embase, and Cochrane literature database, in which cases of ATAAD with CM underwent surgical repair were included. Data for baseline characteristics, mortality, survival were extracted, and risk ratio (RR) values and the pooled mortality were calculated. RESULTS A total of 17 retrospective studies were analyzed, including 1010 cases of ATAAD with CM underwent surgical repair. The pooled early mortality in early reperfusion group was lower (8.1%; CI, 0.02 to 0.168) than that in the central repair group (16.2%; CI, 0.115 to 0.216). The pooled long-term mortality was 7.9% in the early reperfusion cohort and 17.4% the central repair-first cohort, without a statistically significant heterogeneity (I [2] = 51.271%; p = 0.056). The mean time of symptom-onset-to-the-operation-room in all the reports was 8.87 ± 12.3 h. CONCLUSION This meta-analysis suggested that early reperfusion-first may achieved better outcomes compared to central repair-first in ATAAD patients complicated with CM to some extent. Early operation and early restoration of cerebral perfusion may reduce the occurrence of some neurological complications. TRIAL REGISTRATION The meta-analysis was registered in the International Prospective Register of Systematic Reviews database (No. CRD CRD42023475629) on Nov. 8th, 2023.
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Affiliation(s)
- Kang He
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Xiaoli Qin
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Mei Li
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Longrong Bian
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Honghua Yue
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Weitao Liang
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China
| | - Zhong Wu
- Department of Cardiovascular surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, 610041, China.
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Sun J, Xue C, Zhang J, Yang C, Ren K, Zhu H, Zhang B, Li X, Zhao H, Jin Z, Liu J, Duan W. Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection. Heliyon 2023; 9:e18251. [PMID: 37539273 PMCID: PMC10395476 DOI: 10.1016/j.heliyon.2023.e18251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives Acute type A aortic dissection (ATAAD) with severe stenosis or occlusion of the true lumen of aortic arch branch vessels often leads to an increased incidence of severe postsurgical neurological complications and mortality rate. In this study, we aimed to introduce our institutional extra-anatomic revascularization and cannulation strategy with improved postoperative outcomes for better management of patients with cerebral malperfusion in the setting of ATAAD. Methods Twenty-eight patients with ATAAD complicated by severe stenosis or occlusion of the aortic arch branch vessels, as noted on combined computed tomography angiography of the aorta and craniocervical artery, between January 2021 and June 2022 were included in this study. Basic patient characteristics, surgical procedures, hospitalization stays, and early follow-up results were analyzed. Results The median follow-up duration was 16.5 months (interquartile range: 11.5-20.5), with a 100% completion rate. The 30-day mortality rates was 7.1% (2/28 patients); two patients had multiple cerebral infarctions on preoperative computed tomography and persistent coma. Postoperative transient neurological dysfunction occurred in 10.7% (3/28) of the patients, and no new permanent neurological dysfunction occurred. Of all the patients, 3.6% (1/28) had novel acute renal failure. No other deaths, secondary surgeries, or serious complications occurred during the early follow-up period. Conclusions Use of extra-anatomic revascularization and a new cannulation strategy before cardiopulmonary bypass is safe and feasible and may reduce the high incidence of postoperative neurological complications in patients with ATAAD and cerebral malperfusion.
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Affiliation(s)
- Jingwei Sun
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Chao Xue
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jinglong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Chen Yang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Kai Ren
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Hanzhao Zhu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Bin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiayun Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Hongliang Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Zhenxiao Jin
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
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Wang Z, Li K, Xu J, Cheng X, Wang D. Construction of a lactate-related prognostic signature for predicting prognosis after surgical repair for acute type a aortic dissection. Front Physiol 2022; 13:1008869. [PMID: 36467680 PMCID: PMC9709272 DOI: 10.3389/fphys.2022.1008869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/03/2022] [Indexed: 10/14/2023] Open
Abstract
Background: Serum lactate is commonly measured in the perioperative period in patients who have undergone surgery for an acute type A aortic dissection (ATAAD). However, conflicting data has been reported as to whether lactate elevation is associated with short-term prognosis. The aim of the current study was to determine the association between perioperative arterial lactate levels and postoperative 30-day mortality. Methods: Patients who underwent repair of a ATAAD at our institution were retrospectively screened and those with comprehensive measurements of serum lactate before surgery and at 0, 1, 3, 6, 12, and 24 h after surgery in the intensive care unit (ICU) were selected for the analysis. Patients' demographic features and outcomes were reviewed to determine risk factors associated with 30-day mortality using logistic regression modeling. The association between serum lactate levels at different time points and 30-day mortality were analyzed by receiver-operating characteristic curves. Results: 513 patients were identified and retrospectively analyzed for this study including 66 patients (12.9%) who died within 30 days after surgery. Patients who died within 30 days after surgery had elevated lactate levels measured before surgery and at 0, 1, 3, 6, 12, and 24 h after their ICU stay. Lactate measured at 24 h post ICU admission (odds ratio, 2.131; 95% confidence interval, 1.346-3.374; p = 0.001) was a predictor of 30-day mortality. The area under the curve (AUC) for 30-day mortality with lactate levels at 12 h and 24 h post ICU stay were 0.820 and 0.805, respectively. Conclusion: Early elevation of lactate level is correlated with increased 30-day mortality in patients who received ATAAD surgical repair.
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Affiliation(s)
- Zhigang Wang
- Department of Cardio-thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Kai Li
- Department of Cardio-thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jingfang Xu
- Department of Nephrology, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
| | - Xiaofeng Cheng
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
| | - Dongjin Wang
- Department of Cardio-thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Cardio-thoracic Surgery, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China
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