scholarly journals Selective antegrade cerebral perfusion and mild (28°C-30°C) systemic hypothermic circulatory arrest for aortic arch replacement: Results from 1002 patients

2012 ◽  
Vol 144 (5) ◽  
pp. 1042-1050 ◽  
Author(s):  
Andreas Zierer ◽  
Ali El-Sayed Ahmad ◽  
Nestoras Papadopoulos ◽  
Anton Moritz ◽  
Anno Diegeler ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Replacement ◽  
C 30 ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Moderate Hypothermic Circulatory Arrest (≥ 28°C) with Selective Antegrade Cerebral Perfusion for Total Arch Replacement with Frozen Elephant Trunk Technique

2018 ◽  
Vol 67 (05) ◽  
pp. 345-350 ◽  
Author(s):  
Ali El-Sayed Ahmad ◽  
Petar Risteski ◽  
Mahmut Ay ◽  
Nestoras Papadopoulos ◽  
Anton Moritz ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Total Arch Replacement ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Cord Injury ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Objectives The optimal hypothermic level during circulatory arrest in aortic arch surgery remains controversial, particularly in frozen elephant trunk (FET) procedures. We describe herein our experience for total arch replacement with FET technique under moderate systemic hypothermic circulatory arrest (≥ 28°C) during selective antegrade cerebral perfusion. Methods Between January 2009 and January 2016, 38 consecutive patients underwent elective total arch replacement for various aortic arch pathologies with FET technique using the E-vita Open hybrid prosthesis (Jotec GmbH, Hechingen, Germany). Selective unilateral or bilateral cerebral perfusion under moderate systemic hypothermic circulatory arrest (28.7°C ± 0.5°C) was used in all patients. Minimally invasive total arch replacement with FET via partial upper sternotomy was performed in 15 patients (39%) and in the remaining 23 patients (61%) via full sternotomy. Mean late follow-up was 3 ± 2 years and was 98% complete. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 198 ± 58 minutes and the myocardial ischemic time 109 ± 29 minutes. Selective antegrade cerebral perfusion time was 55 ± 6 minutes. Lower body circulatory arrest time was 39 ± 11 minutes. Unilateral cerebral perfusion was performed in 31 patients (82%), and bilateral in 7 patients (18%). Intensive care unit stay was 4 ± 3 days. Thirty-day mortality was 5% (n = 2). Late survival at 3 years was 87 ± 3%. Two patients (5%) required reexploration for bleeding. Patients were discharged after a hospital length of stay of 7 ± 2 days. Postoperative permanent neurologic complication occurred in two patients (5%). Three patients (8%) experienced a transient neurologic disorder. New transient renal replacement therapy was necessary in three patients (8%). No spinal cord injury was noted. Conclusions Our data suggest that moderate systemic hypothermic circulatory arrest (≥ 28°C) in combination with antegrade cerebral perfusion can safely be applied for total aortic arch replacement with FET and offers sufficient neurologic and visceral organ protection.

scholarly journals Total Aortic Arch Replacement: Case Report of the first successful total arch replacement in Nepal and Review of contemporary techniques in arch surgery

2021 ◽  
Vol 18 (2) ◽  
pp. 73-76
Author(s):  
Rabindra Timala ◽  
Ashish Amatya ◽  
Nishes Basnet ◽  
Rupak Pradhan ◽  
Dikshya Joshi ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Aortic Arch Replacement ◽  
The Past ◽  
Branched Graft ◽  
Arch Aneurysm ◽  
Selective Antegrade Cerebral Perfusion ◽  
Antegrade Cerebral Perfusion

Aortic arch replacement is formidable cardiac surgery that is fraught with complications like brain injury, coagulopathy along with high mortality. Over the past several years, various techniques like deep hypothermic circulatory arrest, retrograde cerebral perfusion, and selective antegrade cerebral perfusion along with branched graft techniques have been developed with better early outcomes. We share our experience of successful replacement of ascending and total aortic arch in a 60 years old female, who presented with ascending and aortic arch aneurysm.

scholarly journals Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

2019 ◽  
Vol 1 (3) ◽  
pp. 99-104
Author(s):  
Mohamed Abdel Fouly
Keyword(s):  
Cerebral Infarction ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Surgery ◽  
Significant Difference ◽  
Arch Reconstruction ◽  
Antegrade Cerebral Perfusion

Background: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

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