Brain Protection For Aortic Arch Surgery

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Brain Protection In Aortic Arch Surgery

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Author : Pietro M. Kheir
language : en
Publisher:
Release Date : 2012

Brain Protection In Aortic Arch Surgery written by Pietro M. Kheir and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with categories.

The aortic arch gives birth to three major branches: the innominate artery, and the left carotid and subclavian arteries, and is therefore responsible for the whole cerebral perfusion. Thoracic aortic aneurysm (T AA) has a prevalence of 4.2% in the general population, involving the aortic arch in 10% of the cases. TAA and dissection are most commonly caused by atherosclerosis, hypertension and connective tissue disease. Surgical indications are based on the presence of dissection, symptomatology, size, and growth rate. In aortic arch replacement, the arch is substituted by a prosthetic graft where the three branches are reimplanted. The procedure necessitates clamping proximally and distally to the arch vessels, which compromises the circulation towards the brain. Many strategies have been used to overcome the heavy neurological burden of aortic arch surgery, using deep hypothermic circulatory arrest, antegrade cerebral perfusion (ACP), or retrograde cerebral perfusion. Ongoing debate exists regarding the optimal strategy. The department of Cardiovascular and Thoracic surgery at Notre-Dame des Secours University Hospital Center (NDSUHC) has an experience in this surgery that goes back to 1990, using ACP by innominate and left carotid artery cannulation, with moderate hypothermia. A series of 27 cases operated for aortic arch replacement has been studied. Methods: We retrospectively studied the charts of 27 patients (20 men, age 57 +/-11.6) who underwent aortic arch replacement at NDSUHC between 1990 and 2010. We studied surgical outcome in mortality and neurological morbidity and their relations with age, total cardio-pulmonary bypass (CPB) time, and emergency setting. We also compared these outcomes to the ones described in the literature, after an extensive PubMed archive review. Results: The studied population was young relatively to the studied disease and had increased cardiovascular risk factors. Mortality was 14.8%, occurrence of stroke was 4.17%, and transient neurological deficit 8.33%. Age (p=0.02), as well as total CPB time (p=0.002) were risks factors for neurological morbidity. Emergency setting was a risk factor for mortality and overall complications (RR=ll.8, p=0.004). Conclusion: ACP through the innominate and left carotid artery with moderate hypothermia is a safe strategy for cerebral protection during aortic arch surgery. Further research is required to determine the gold standard. Until then, every institution should choose the procedure it performs best for brain protection. The method used at NDSUHC achieved satisfying outcomes with low complications; emergency setting was a risk factor for mortality, age and total CPB time for neurological morbidity.

Brain Protection In Aortic Arch Surgery

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Author : Vesa Anttila
language : en
Publisher:
Release Date : 2000

Brain Protection In Aortic Arch Surgery written by Vesa Anttila and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2000 with categories.

Aortic Arch Surgery

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Author : Joseph S. Coselli
language : en
Publisher: John Wiley & Sons
Release Date : 2009-01-26

Aortic Arch Surgery written by Joseph S. Coselli and has been published by John Wiley & Sons this book supported file pdf, txt, epub, kindle and other format this book has been release on 2009-01-26 with Medical categories.

Focusing exclusively on the surgical management of aortic arch disease in adults, this concise reference provides authoritative guidance on both standard and alternative approaches from internationally recognized experts. Topics include: general principles of aortic diseases imaging techniques intraoperative management neurologic protection strategies options for aortic repair surgical treatment of specific problems complications Abundant illustrations demonstrate significant imaging study findings and depict key techniques and strategies. With its detailed descriptions and thorough explanations of a wide variety of approaches to imaging, brain protection and monitoring, and aortic reconstruction, Aortic Arch Surgery: Principles, Strategies and Outcomes gives practicing and prospective thoracic and cardiovascular surgeons access to the full armamentarium of management options. Anesthesiologists, perfusionists, neurologists, radiologists, and others who have a special interest in treating patients with thoracic aortic disease will also find this book an invaluable source of dependable information.

Brain Protection In Aortic Surgery

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Author : Yasunaru Kawashima
language : en
Publisher: Elsevier Science & Technology
Release Date : 1997

Brain Protection In Aortic Surgery written by Yasunaru Kawashima and has been published by Elsevier Science & Technology this book supported file pdf, txt, epub, kindle and other format this book has been release on 1997 with Medical categories.

Hardbound. This book summarizes and reviews the current techniques and recent advances in brain protection during aortic surgery which were presented at the Symposium. Clinical application and basic mechanism of the methods of hypothermic circulatory arrest, antegrade cerebral perfusion and retrograde cerebral perfusion are discussed. This book will provide the basis of better and further understanding of brain protection in aortic surgery. It is directed not only at physicians, but all medical and allied personnel who deal with patients before, during or after aortic arch surgery. They include cardiovascular surgeons, cardiologists, neurologists and intensivists. Other potential readers are residents, nurses, medical students and paramedical personnel.

Cerebral Protection In Cerebrovascular And Aortic Surgery

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Author : Jürgen Ennker
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-06

Cerebral Protection In Cerebrovascular And Aortic Surgery written by Jürgen Ennker and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-06 with Medical categories.

Among the greatest challenges in cardiovascular surgery today remain operations on aortic arch pathology, supraaortic vessels, and the protection of the brain from hypoxic or ischemic injury during these delicate operations. Since DeBakey's first successful repair of an aortic arch aneurysm in 1957, understanding of the aortic arch pathology, neuroprotective strategies, neuromonitoring and surgical technique have markedly improved. Although the specific surgical procedures have reached an advanced standard and general acceptance, many questions remain unanswered and have contributed to ongoing controversy. Cerebral Protection in Cerebrovascular and Aortic Surgery presents the current knowledge of understanding causes and pathogenesis of cerebral damage during surgery on the aortic arch and supraaortic vessels and prevention of brain damage by specific surgical therapy.

Optimising Brain Protection During Aortic Arch Surgery

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Author : James Clifford Halstead
language : en
Publisher:
Release Date : 2007

Optimising Brain Protection During Aortic Arch Surgery written by James Clifford Halstead and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with categories.

Brain Protection For Aortic Arch Surgery

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Author : Vinay Garg
language : en
Publisher:
Release Date : 2020

Brain Protection For Aortic Arch Surgery written by Vinay Garg and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2020 with categories.

Neuroprotection remains the cornerstone of successful aortic surgery however there is no consensus as to the optimal strategy. We compared the safety and efficacy of innominate to axillary artery cannulation for delivering antegrade cerebral protection (ACP) during proximal aortic arch surgery. This randomized study allocated 111 individuals to either innominate or axillary cannulation. The primary safety outcome was the appearance of new severe ischemic lesions on the postoperative compared with the preoperative diffusion-weighted (DW)- MRI. The primary efficacy outcome was the between-groups difference in total operative time. 102 individuals were included in the primary safety analysis. New severe ischemic lesions occurred in 19 participants (38.8%) in the axillary vs. 18 (34%) in the innominate group (p for non-inferiority = 0.0009). Total operative times were comparable (p for superiority = 0.47). Our DW-MRI assessments indicate that ACP with innominate cannulation is safe and affords similar neuroprotection to axillary cannulation during aortic surgery.

Brain Protection In Cardiac Surgery

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Author : Robert S. Bonser
language : en
Publisher: Springer Science & Business Media
Release Date : 2010-12-15

Brain Protection In Cardiac Surgery written by Robert S. Bonser and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2010-12-15 with Medical categories.

Part of the Monographs in Cardiac Surgery Series – Introducing ‘basic science into the cardiac operating room’. Fast systematic review of small areas of cardiac surgery including up-to-date information. This will allow more rapid publication than the alternative cardiac surgery ‘tomes’. This entry into the series will provide readers with a complete review of the current understanding in brain injury and the methods used to avoid or limit its effects on patient morbidity and mortality.

Cardio Aortic And Aortic Surgery

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Author : S. Kawada
language : en
Publisher: Springer Science & Business Media
Release Date : 2012-12-06

Cardio Aortic And Aortic Surgery written by S. Kawada and has been published by Springer Science & Business Media this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012-12-06 with Medical categories.

As societies have aged and aortic diseases have become more prevalent, advances in diagnostic imaging and surgical techniques have brought significantly improved results for patients. In cardiovascular surgery, important questions remain to be addressed, however. "Strategy for Cardio-aortic and Aortic Surgery" was the theme of the 7th Keio University International Symposium for Life Sciences and Medicine. Meeting in Tokyo, researchers and specialists in cardiac surgery from around the world discussed crucial issues in their field. Papers from the symposium, collected in this volume, cover a broad range of topics, including recent advances in diagnostic imaging, brain protection during aortic surgery, spinal protection during thoracoabdominal aneurysm repair, treatment of type A acute aortic dissection, and stent-grafts and less-invasive aortic surgery. This unique book provides valuable information especially for aortic, cardiovascular, and thoracic surgeons.

Sufficiency Of Brain Cooling Before Circulatory Arrest During Aortic Arch Surgery A Combined Assessment

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Author : Yergali Miyerbekov
language : en
Publisher:
Release Date : 2017

Sufficiency Of Brain Cooling Before Circulatory Arrest During Aortic Arch Surgery A Combined Assessment written by Yergali Miyerbekov and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2017 with categories.

Background. Monitoring of temperature and EEG are routine approach to assess the brain coolingsufficiency in pts undergoing aortic arch surgery. The jugular bulb fibreoptic oxymetry is valuablemethod to evaluate of brain oxygenation and metabolism (1,2).The aim of study was to determinate efficiency of hypothermic brain protection in pts underwent aorticarch surgery.Methods. After local Ethic Committee approval and informed consent 35 pts 13-69 yo (44.9u00b110.1) wereoperated on aortic arch with deep hypothermic circulatory arrest (HCA). To determinate sufficiency ofbrain cooling in pts we used monitoring of temperatures (nasal+rectal) and EEG.We studied EEG, PO2, PCO2, SO2, glucose (Glu) level in arterial and jugular bulb blood. Arteriovenousoxygen and carbon dioxide difference (a-jbO2, jb-aCO2), oxygen extraction and arteriovenous glucosedifference (a-jbGlu) were assessed.Results. Duration of HCA was 48.6u00b112.8 min. Deep depression of EEG and Tnasal 13.5u00b10.5 and Trectal15.0u00b10.6 Cu00b0 were achieved before HCA.SjbO2 curve characterized by gradual rising during cooling and u00abplateauu00bb, reaching arterial oxygenationlevel (98.4u00b10.4%).Correlation of EEG activity and SbjO2 with core temperatures was found.a-jbGlu decreased 4 fold before HCA.We observed most high values of u0420jbu041e2 and Sjbu041e2 (201.8u00b154.5 mmHg and 98.4u00b10.4% respectively),PaO2 and SaO2 were 410.2u00b184.8 mmHg and 99% respectively before HCA.Early postoperative mortality was 28.6%. None of lethality related to brain injury.Discussion.Brain protection with hypothermia in pts aims to reduce oxygen demand and suppress its metabolism.The brain oxygenation and metabolism monitoring should be used to estimate adequacy of itsprotection with cooling during deep HCA.We suggest as additional metabolic criteria of brain cooling sufficiency before HCA:1. SjbO2 curve with gradual increasing and u00abplateauu00bb reaching during HCA (fibreoptic oxymetry);2. Equalization of SbjO2 with SaO2;3. Significant reducing of oxygen and glucose extraction by brain.The problem is not highlighted enough yet and needs further research.