Retrograde and Antegrade Cerebral Perfusion: Results in Short Elective Arch Reconstructive Times
| Autor: | Nimesh D. Desai, Roberto Di Bartolomeo, Patrick Moeller, Y. Joseph Woo, Alberto Pochettino, G. William Moser, Wilson Y. Szeto, Davide Pacini, Luca Di Marco, Joseph E. Bavaria, Doreen Cowie, Rita K. Milewski |
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| Přispěvatelé: | RK. Milewski, D. Pacini, GW. Moser, P. Moeller, D. Cowie, WY. Szeto, YJ. Woo, N. Desai, L. Di Marco, A. Pochettino, R. Di Bartolomeo, JE. Bavaria |
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Aortic arch Time Factors Aorta Thoracic Risk Assessment Brain Ischemia Cohort Studies Aortic aneurysm Postoperative Complications medicine.artery Open aortic surgery Confidence Intervals Odds Ratio medicine Humans Cerebral perfusion pressure Aged Retrospective Studies Analysis of Variance Aorta Cardiopulmonary Bypass Aortic Aneurysm Thoracic business.industry Perioperative Middle Aged medicine.disease Perfusion Survival Rate Circulatory Arrest Deep Hypothermia Induced Logistic Models Treatment Outcome Cerebrovascular Circulation Anesthesia Multivariate Analysis Deep hypothermic circulatory arrest Female Surgery Cardiology and Cardiovascular Medicine business Vascular Surgical Procedures Follow-Up Studies |
| Zdroj: | The Annals of Thoracic Surgery. 89:1448-1457 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2010.01.056 |
| Popis: | Debate remains regarding optimal cerebral circulatory management during relatively noncomplex, short arch reconstructive times. Both retrograde cerebral perfusion with deep hypothermic circulatory arrest (RCP/DHCA) and antegrade cerebral perfusion with moderate hypothermic circulatory arrest (ACP/MHCA) have emerged as established techniques. The aim of the study was to evaluate perioperative outcomes between antegrade and retrograde cerebral perfusion techniques for elective arch reconstruction times less than 45 minutes.Between 1997 and September 2008, 776 cases from two institutions were reviewed to compare RCP/DHCA and ACP/MHCA perfusion techniques. At the University of Pennsylvania, 682 were treated utilizing RCP/DHCA cerebral protection. At the University of Bologna, 94 were treated with ACP/MHCA and bilateral cerebral perfusion.Mean cerebral ischemic time and visceral ischemic time differed between RCP/DHCA and ACP/MHCA (p0.001). Multivariate analysis showed age more than 65 years, atherosclerotic aneurysm, and cross-clamp time as predictors of the composite endpoint of mortality, neurologic event, and acute myocardial infarction. There was no significant difference in permanent neurologic deficit, temporary neurologic dysfunction, or renal failure, between RCP/DHCA and ACP/MHCA. Mortality was comparable across both techniques.Both RCP/DHCA and ACP/MHCA have emerged as effective techniques for selected aortic arch operations with low morbidity and mortality. Univariate analysis revealed no statistically significant differences in primary or secondary outcomes between techniques for aortic reconstruction times less than 45 minutes. Data from this study demonstrate that selective use of either RCP/DHCA or ACP/MHCA provides excellent cerebral and visceral outcomes for elective open aortic surgery with short arch reconstructive times. |
| Databáze: | OpenAIRE |
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