Axillary cerebral perfusion for arch surgery in acute type A dissection under moderate hypothermia
| Autor: | Nicolas Paul Henri Murith, Marek Bednarkiewicz, Aristotelis Panos, Gregory Khatchatourov |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Aortic arch Adult Male medicine.medical_specialty Perfusion scanning Dissection (medical) law.invention Aortic Aneurysm/surgery Brain Ischemia Aortic aneurysm Axillary artery law Hypothermia Induced medicine.artery Catheterization Peripheral medicine Cardiopulmonary bypass Perfusion/methods Humans Cerebral perfusion pressure Aneurysm Dissecting/surgery Aged Aortic dissection Aged 80 and over Catheterization Peripheral/methods Cardiopulmonary Bypass ddc:617 business.industry Cardiopulmonary Bypass/methods General Medicine Middle Aged medicine.disease Surgery Aortic Aneurysm Perfusion Aortic Dissection Treatment Outcome Cerebrovascular Circulation Acute Disease cardiovascular system Axillary Artery Female Cardiology and Cardiovascular Medicine business Brain Ischemia/prevention & control |
| Zdroj: | European Journal of Cardio-Thoracic Surgery, Vol. 29, No 6 (2006) pp. 1036-9 |
| ISSN: | 1010-7940 |
| Popis: | Backgound: Aortic arch surgery is still associated with increased mortality and morbidity especially in acute type A aortic dissection. Adequate brain protection is essential and commonly performed by either antegrade selective perfusion of the brachiocephalic arteries or an interval of profound hypothermic circulatory arrest. We present our experience for open aortic arch repair with continuous antegrade brain perfusion by means of direct cannulation of the right axillary artery, under moderate hypothermia in patients with acute type A aortic dissection. Methods: In, 25 consecutive patients (17 men) with a mean age of 62.6 ± 14.8 years, aortic repair extended to the arch, for acute type A aortic dissection, was performed through a midline sternotomy. The right axillary artery was used for arterial systemic and brain perfusion at a rectal temperature of 25-27 °C. Results: Mean duration of CPB and aortic cross-clamping was 241 ± 55 and 155 ± 72 min, respectively. The mean duration of circulatory arrest of the lower body and brain perfusion was 39.7 (range, 24-55 min). All the patients survived the procedure and all but one were discharged from hospital. One patient had left arm paralysis which he recovered the first postoperative month. There were no other transient or permanent neurologic deficits. A CT scan was performed at discharge for routine postoperative evaluation. There were no local neurovascular complications related to the cannulation site except for one local re-exploration for bleeding. Conclusions: The absence of any major permanent neurologic deficit or any visceral damages in our patients suggests that continuous moderate hypothermic cerebral perfusion, with an interval of circulatory arrest of the lower body, is adequate for acute type A aortic dissection surgery, allowing safe open repair of the distal aortic arch |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|