Selective Antegrade Cerebral Perfusion Attenuates Brain Metabolic Deficit in Aortic Arch Surgery
| Autor: | H. Kaukuntla, T. Clutton-Brock, A.S. Walker, M. Faroqui, Domenico Pagano, R.M. Bracewell, Robert S. Bonser, D.K. Harrington |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
Adult
Male Aortic arch Middle Cerebral Artery Ultrasonography Doppler Transcranial Aorta Thoracic Neuropsychological Tests Hypothermia Induced Physiology (medical) medicine.artery medicine Humans Thoracic aorta Hospital Mortality Prospective Studies Cerebral perfusion pressure Hypoxia Brain Stroke Aged Aorta business.industry Incidence Carbon Dioxide Middle Aged medicine.disease Aortic Aneurysm Transcranial Doppler Oxygen Perfusion Aortic Dissection Treatment Outcome Hematocrit Cerebrovascular Circulation Anesthesia Middle cerebral artery Heart Arrest Induced Brain Damage Chronic Female Cardiology and Cardiovascular Medicine business Blood Flow Velocity |
| Zdroj: | Circulation. 110 |
| ISSN: | 1524-4539 0009-7322 |
| Popis: | Background— Aortic arch surgery has a high incidence of brain injury. This may in part be caused by a cerebral metabolic deficit observed after hypothermic circulatory arrest (HCA). We hypothesized that selective antegrade cerebral perfusion (SACP) would attenuate this phenomenon. Methods and Results— In a prospective randomized trial, 42 adult patients were allocated to either HCA (22) or SACP. HCA occurred at a nasopharyngeal temperature of 15°C and SACP at a corporeal temperature of 25°C with cerebral perfusion at 15°C. Paired arterial and jugular venous samples were taken before and after arrest. Continuous transcranial Doppler monitoring of middle cerebral artery velocity (MCAV) was performed. Neuropsychometric testing was performed preoperatively and at 6 and 12 weeks postoperatively. There were 3 hospital deaths (7.1%), 2 strokes (4.8%), and 6 episodes of transient neurological deficit (14.3%). From before to after arrest, jugular bulb pO 2 changed by −21.67 mm Hg (26.4) in the HCA group versus +2.27 mm Hg (18.8) in the SACP group ( P =0.007). Oxygen extraction changed by +1.7 mL/dL (1.3) in the HCA group versus −1 mL/dL (2.4) in the SACP group ( P P =0.001). Incidence of neuropsychometric deficit at 6 weeks was 6/12 (50%) in HCA patients and 8/10 (80%) in SACP patients ( P =0.2), and at 12 weeks was 6/16 (38%) in HCA patients and 4/11 (36%) in SACP patients ( P =1). Conclusions— SACP attenuates the metabolic changes seen after HCA. Further studies are required to assess optimal perfusion conditions and clinical outcome. |
| Databáze: | OpenAIRE |
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