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Neuroprotective effect of pressure-oriented flow regulation and pH-stat management in selective antegrade brain perfusion during total aortic arch repair.
Ito, Hisato; Mizumoto, Toru; Sawada, Yasuhiro; Fujinaga, Kazuya; Tempaku, Hironori; Yamamoto, Yasunori; Tsutsui, Katsuhiro; Shimpo, Hideto.
Afiliación
  • Ito H; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Mizumoto T; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Sawada Y; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Fujinaga K; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Tempaku H; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Yamamoto Y; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Tsutsui K; Department of Cardiothoracic Surgery, Anjo Kosei Hospital, Anjo, Aichi, Japan.
  • Shimpo H; Department of Thoracic and Cardiovascular Surgery, Mie University, Tsu, Mie, Japan.
Interact Cardiovasc Thorac Surg ; 25(4): 565-570, 2017 10 01.
Article en En | MEDLINE | ID: mdl-28637170
ABSTRACT

OBJECTIVES:

The aim of this study was to assess the safety and effectiveness of our selective antegrade brain perfusion (SABP) strategy, which is characterized by moderate hypothermic and low-pressure management under pH-stat using a completely closed cardiopulmonary bypass circuit with a single centrifugal pump.

METHODS:

Forty-nine consecutive patients (median age, 74) underwent total aortic arch replacement using a 4-branched graft. SABP was conducted with individual cannulation in all arch vessels. The SABP flow rate was monitored, and the flow rates of each arch vessel were also measured in patients with available data.

RESULTS:

One patient died of cerebral infarction, and 7 had transient neurological deficits without apparent findings on postoperative imaging studies and without residual sequels at hospital discharge. The operation, cardiopulmonary bypass, cardiac arrest, circulatory arrest and SABP times were 327 min (interquartile range, 292-381), 211 (184-247), 107 (84.8-138.3), 54.0 (48-68) and 137 (114-158), respectively. The total flow of the SABP was 18.1 ml/kg/min (15.7-20.9). The flow rates of the brachiocephalic, the left carotid and the left subclavian arteries were 9.5 ml/kg/min (7.7-11.5), 4.2 (2.8-5.7) and 4.5 (3.7-5.5), respectively. Only the flow rate of the brachiocephalic artery was significantly correlated with the total SABP flow rate (Spearman rank correlation coefficient, r = 0.58, P < 0.01).

CONCLUSIONS:

The moderate hypothermic, high-flow, low-pressure SABP strategy with pH-stat management can be applied in adult aortic surgery; however, the feasibility and effectiveness of this concept need further evaluation in a prospective controlled study.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aorta Torácica / Perfusión / Complicaciones Posoperatorias / Isquemia Encefálica / Circulación Cerebrovascular / Aneurisma de la Aorta Torácica / Hipotermia Inducida Tipo de estudio: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Interact Cardiovasc Thorac Surg Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2017 Tipo del documento: Article País de afiliación: Japón

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Aorta Torácica / Perfusión / Complicaciones Posoperatorias / Isquemia Encefálica / Circulación Cerebrovascular / Aneurisma de la Aorta Torácica / Hipotermia Inducida Tipo de estudio: Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Adult / Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Asia Idioma: En Revista: Interact Cardiovasc Thorac Surg Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2017 Tipo del documento: Article País de afiliación: Japón