Safety of Unilateral Antegrade Cerebral Perfusion at 22°C Systemic Hypothermia
DOI:
https://doi.org/10.1532/HSF98.20071201Abstract
Background. The superiority of antegrade cerebral perfusion (ACP) in aortic surgery is widely accepted, but the sufficiency of unilateral cerebral perfusion and the optimal systemic temperature during the operation are still controversial.
Methods. Thirty patients who underwent operation with unilateral ACP at a systemic temperature of 22°C between January 2005 and September 2007 were included in this study. The mean age (±SD) of the patients was 58 ± 11 years, and 21 (70%) of the patients were male. The indication for surgery was acute type A aortic dissection in 14 patients (47%), degenerative aortic aneurysm in 9 patients (30%), dissecting aortic aneurysm in 6 patients (20%), and intramural hematoma in 1 patient (3%). Supracoronary ascending aorta replacement was performed in 13 patients (43%). Eight patients (27%) underwent ascending aorta and hemiarch replacement. The Bentall procedure was performed with hemiarch replacement in 3 patients (10%). Three patients (10%) underwent total aortic arch replacement, and 2 patients (7%) underwent the Bentall procedure. The ascending aorta, aortic arch, and descending aorta were replaced in 1 patient (3%).
Results. Hospital mortality was limited to 1 patient (3.3%). A permanent or transient neurologic deficit was not detected in any of the survivors. The mean cardiopulmonary bypass, aortic cross-clamp, and ACP times were 144 ± 40 minutes, 82 ± 28 minutes, and 30 ± 11 minutes, respectively. The mean mechanical ventilation time was 18 ± 9 hours. The mean stay in the intensive care unit was 2.3 ± 1.1 days, and the mean hospital stay was 12 ± 6 days.
Conclusion. Unilateral ACP with systemic hypothermia at 22°C is safe and has satisfactory clinical results. Establishing ACP via cannulation of the right axillary artery is fast and simple. The presence of fewer cannulas in the operation field provides an operative condition as convenient as the deep hypothermic circulatory arrest technique.
References
Cook RC, Gao M, Macnab AJ, Fedoruk LM, Day N, Janusz MT. 2006. Aortic arch reconstruction: safety of moderate hypothermia and antegrade cerebral perfusion during systemic circulatory arrest. J Card Surg 21:158-64.nDossche KM, Schepens MA, Morshuis WJ, Muysoms FE, Langemeijer JJ, Vermeulen FE. 1999. Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta. Ann Thorac Surg 67:1904-10.nEhrlich MP, Ergin MA, McCullough JN, et al. 2000. Predictors of adverse outcome and transient neurological dysfunction after ascending aorta/hemiarch replacement. Ann Thorac Surg 69:1755-63.nEhrlich MP, McCullough JN, Zhang N, et al. 2002. Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg 73:191-7.nHagl C, Ergin MA, Galla JD, et al. 2001. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg 121:1107-21.nHarrington DK, Fragomeni F, Bonser RS. 2007. Cerebral perfusion. Ann Thorac Surg 83:S799-804.nKamiya H, Hagl C, Kropivnitskaya I, et al. 2007. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg 133:501-9.nKaneda T, Saga T, Onoe M, et al. 2005. Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery. Scand Cardiovasc J 39:87-90.nKazui T, Washiyama N, Muhammad BA, et al. 2000. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg 70:3-8.nKazui T, Yamashita K, Washiyama N, et al. 2007. Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg 83:S796-8.nKhaladj N, Peterss S, Oetjen P, et al. 2006. Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection? Eur J Cardiothorac Surg 30:492-8.nKüçüker SA, Ozatik MA, Sarita? A, Ta?demir O. 2005. Arch repair with unilateral antegrade cerebral perfusion. Eur J Cardiothorac Surg 27:638-43.nOlsson C, Thelin S. 2006. Antegrade cerebral perfusion with a simplified technique: unilateral versus bilateral perfusion. Ann Thorac Surg 81:868-74.nOzatik MA, Küçüker SA, Tülüce H, et al. 2004. Neurocognitive functions after aortic arch repair with right brachial artery perfusion. Ann Thorac Surg 78:591-5.nPacini D, Leone A, Di Marco L, et al. 2007. Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg 31:618-22.nPanos A, Murith N, Bednarkiewicz M, Khatchatourov G. 2006. Axillary cerebral perfusion for arch surgery in acute type A dissection under moderate hypothermia. Eur J Cardiothorac Surg 29:1036-9.nPapantchev V, Hristov S, Todorova D, et al. 2007. Some variations of the circle of Willis, important for cerebral protection in aortic surgery: a study in Eastern Europeans. Eur J Cardiothorac Surg 31:982-9.nSanioglu S, Sokullu O, Yapici F, et al. 2007. Axillary artery cannulation in surgery of the ascending aorta and the aortic arch. Turk Gogus Kalp Damar Cerrahisi Dergisi 15:197-2.nStrauch JT, Spielvogel D, Lauten A, et al. 2005. Optimal temperature for selective cerebral perfusion. J Thorac Cardiovasc Surg 130:74-82.nSvensson LG, Crawford ES, Hess KR, et al. 1993. Deep hypothermia with circulatory arrest: determinants of stroke and early mortality in 656 patients. J Thorac Cardiovasc Surg 106:19-31.nTa?demir O, Sarita? A, Küçüker S, Ozatik MA, Sener E. 2002. Aortic arch repair with right brachial artery perfusion. Ann Thorac Surg 73:1837-42.nZierer A, Aybek T, Risteski P, Dogan S, Wimmer-Greinecker G, Moritz A. 2005. Moderate hypothermia (30°C) for surgery of acute type A aortic dissection. Thorac Cardiovasc Surg 53:74-9.nBonser RS, Wong CH, Harrington D, et al. 2002. Failure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest. J Thorac Cardiovasc Surg 123:943-50.n
