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General Thoracic and Cardiovascular Surgery
Erschienen in: General Thoracic and Cardiovascular Surgery 1/2019

03.01.2018 | SPECIAL EDITION

Brain protection in aortic arch aneurysm: antegrade or retrograde?

verfasst von: Amer Harky, Matthew Fok, Mohamad Bashir, Anthony L. Estrera

Erschienen in: General Thoracic and Cardiovascular Surgery | Ausgabe 1/2019

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Abstract

During open aortic arch repair, there is an interruption of cerebral perfusion and to prevent neurological sequelae, the hypothermic circulatory arrest has been established to provide sufficient brain protection coupled with adjuncts including retrograde and antegrade cerebral perfusion. To date, brain protection during open aortic arch repair is a contested topic as to which provides superior brain protection with little evidence existing to suggest supremacy of one modality over the other. This article reviews current literature reflecting on key and emerging studies in brain protection and their associated outcomes in patients undergoing open aortic arch surgery.
Literatur
1.
CooleyDA, MahaffeyDE, DeBakeyME. Total excision of the aortic arch for aneurysm. Surg Gynecol Obstet. 1955;101:667–72.PubMed
2.
GrieppRB, StinsonEB, HollingsworthJF, BuehlerD. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975;70(6):1051–63.PubMed
3.
BashirM, ShawM, DesmondM, KuduvalliM, FieldM, OoA. Cerebral protection in hemi-aortic arch surgery. Ann Cardiothorac Surg. 2013;2(2):239–44.PubMedPubMedCentral
4.
5.
GrieppR, ErginM, LansmanJ. The physiology of hypothermic circulatory arrest. Semin Thorac Cardiovasc Surg. 1991;3:188–93.PubMed
6.
PercyA, WidmanS, RizzoJA, TranquilliM, ElefteriadesJA. Deep hypothermic circulatory arrest in patients with high cognitive needs: full preservation of cognitive abilities. Ann Thorac Surg. 2009;87(1):117–23.CrossRefPubMed
7.
DiEusanioM, WesselinkRM, MorshuisWJ, et al. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: a retrospective comparative study. J Thorac Cardiovasc Surg. 2003;125:849–54.CrossRefPubMed
8.
SakamotoT, ZurakowskiD, DuebenerLF, et al. Combination of alpha-stat strategy and hemodilution exacerbates neurologic injury in a survival piglet model with deep hypothermic circulatory arrest. Ann Thorac Surg. 2002;73:180–9 (discussion 189–190).CrossRefPubMed
9.
ZiganshinBA, RajbanshiBG, TranquilliM, FangH, RizzoJA, ElefteriadesJA. Straight deep hypothermic circulatory arrest for cerebral protection during aortic arch surgery: safe and effective. J Thorac Cardiovasc Surg. 2014;148:888–98 (discussion 898–900).CrossRefPubMed
10.
GegaA, RizzoJA, JohnsonMH, TranquilliM, FarkasEA, ElefteriadesJA. Straight deep hypothermic arrest: experience in 394 patients supports its effectiveness as a sole means of brain preservation. Ann Thorac Surg. 2007;84(3):759–66 (discussion 766–7).CrossRefPubMed
11.
SvenssonLG, BlackstoneEH, RajeswaranJ, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk?Ann Thorac Surg. 2004;78:1274–84 (discussion 1274–84).CrossRefPubMed
12.
MilewskiRK, PaciniD, MoserGW, et al. Retrograde and antegrade cerebral perfusion: results in short elective arch reconstructive times. Ann Thorac Surg. 2010;89:1448–57.CrossRefPubMed
13.
LeshnowerBG, MyungRJ, KilgoPD, VassiliadesTA, VegaJD, ThouraniVH, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion: a contemporary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg. 2010;90(2):547–54.CrossRefPubMed
14.
LeshnowerBG, MyungRJ, ThouraniVH, et al. Hemiarch replacement at 28 degrees celsius: an analysis of mild and moderate hypothermia in 500 patients. Ann Thorac Surg. 2012;93:1910–5.CrossRefPubMed
15.
GutscheJT, FeinmanJ, SilvayG, et al. Practice variations in the conduct of hypothermic circulatory arrest for adult aortic arch repair: Focus on an emerging European paradigm. Heart Lung Vessels. 2014;6:43–51.PubMed
16.
PaciniD, DiMarcoL, LeoneA, et al. Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: clinical outcomes in elderly patients. Eur J Cardiothorac Surg. 2012;42:249–53.CrossRefPubMed
17.
UedaY, MikiS, KusuharaK, et al. Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg (Torino). 1990;31:553–8.
18.
19.
MillsNL, OchsnerJL. Massive air embolism during cardiopulmonary bypass. Causes, prevention, and management. J Thorac Cardiovasc Surg. 1980;80:708–17.PubMed
20.
LemoleGM, StrongMD, SpagnaPM, et al. Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis. J Thorac Cardiovasc Surg. 1982;83:249–55.PubMed
21.
KawataM, TakamotoS, KitahoriK, et al. Intermittent pressure augmentation during retrograde cerebral perfusion under moderate hypothermia provides adequate neuroprotection: an experimental study. J Thorac Cardiovasc Surg. 2006;132:80–8.CrossRefPubMed
22.
KawataM, SekinoM, TakamotoS, et al. Retrograde cerebral perfusion with intermittent pressure augmentation provides adequate neuroprotection: diffusion- and perfusion-weighted magnetic resonance imaging study in an experimental canine model. J Thorac Cardiovasc Surg. 2006;132:933–40.CrossRefPubMed
23.
YangY, YangL, SunJ, et al. A modified protocol for retrograde cerebral perfusion: magnetic resonance spectroscopy in pigs. Eur J Cardiothorac Surg. 2013;43:1065–71.CrossRefPubMed
24.
LeeT-Y, SafiHJ, EstreraAL. Cerebral Perfusion in Aortic Arch Surgery: Antegrade, Retrograde, or Both? Coselli JS. ed. Tex Heart Inst J. 2011;38(6):674–7.PubMedPubMedCentral
25.
EstreraAL, GaramiZ, MillerCC3rd, SheinbaumR, HuynhTT, PoratEE, et al. Determination of cerebral blood flow dynamics during retrograde cerebral perfusion using power M-mode transcranial Doppler. Ann Thorac Surg. 2003;76(3):704–10.CrossRefPubMed
26.
27.
EstreraAL, MillerCC3rd, LeeTY, ShahP, SafiHJ. Ascending and transverse aortic arch repair: the impact of retrograde cerebral perfusion. Circulation. 2008;118(14 Suppl):S160–6.CrossRefPubMed
28.
CoselliJS. Retrograde cerebral perfusion in surgery for aortic arch aneurysms. In: EnnkerJ, CoselliJS, HetzerR, editors. Cerebral protection in cerebraovascular and aortic surgery. Darmstadt: Steinkopf Verlag; 1997. pp. 239–49.CrossRef
29.
SafiHJ, MillerCC3rd, LeeTY, et al. Repair of ascending and transverse aortic arch. J Thorac Cardiovasc Surg. 2011;142:630–3.CrossRefPubMed
30.
OkitaY, TakamotoS, AndoM, et al. Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusion: no relation of early death, stroke, and delirium to the duration of circulatory arrest. J Thorac Cardiovasc Surg. 1998;115:129–38.CrossRefPubMed
31.
GirardiLN, ShavladzeN, SedrakyanA, Neragi-MiandoabS. Safety and efficacy of retrograde cerebral perfusion as an adjunct for cerebral protection during surgery on the aortic arch. J Thorac Cardiovasc Surg. 2014;148(6):2927–33.CrossRefPubMed
32.
EstreraAL, MillerCC, LeeTY, et al. Integrated cerebral perfusion for hypothermic circulatory arrest during transverse aortic arch repairs. Eur J Cardiothorac Surg. 2010;38:293–8.CrossRefPubMed
33.
34.
EhrlichMP, HaglC, McCulloughJN, ZhangN, ShiangH, BodianC, GrieppRB. Retrograde cerebral perfusion provides negligible flow through brain capillaries in the pig. J Thorac Cardiovasc Surg. 2001;122(2):331–8.CrossRefPubMed
35.
FristWH, BaldwinJC, StarnesVA, et al. A reconsideration of cerebral perfusion in aortic arch replacement. Ann Thorac Surg. 1986;42:273 – 81.CrossRefPubMed
36.
BachetJ, GuilmetD, GoudotB, et al. Cold cerebroplegia. A new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg. 1991;102:85–93. (discussion 93–4).PubMed
37.
KazuiT, InoueN, YamadaO, et al. Selective cerebral perfusion during operation for aneurysms of the aortic arch: a reassessment. Ann Thorac Surg. 1992;53:109–14.CrossRefPubMed
38.
EtzCD, PlestisKA, KariFA, et al. Axillary cannulation significantly improves surgival and enurologic outcome after atherosclerotic aneurysm repair of the aortic root and ascending aorta. Ann Thorac Surg. 2008;86:441–6. (discussion 446–7).CrossRefPubMed
39.
HarringtonD, WalkerA, KaukuntaH, et al. Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery. Circulation. 2004;110(Suppl. 1):II231–II236.PubMed
40.
DiEusanioM, ScheppensM, MorschuisW, DiBartolomeoR, PierangeliA, DosscheKM. Antegrade selective cerebral perfusion during operations on the thoracic aorta: factors influencing survival and neurologic outcome in 413 patients. J Thorac Cardiovasc Surg. 2002;124:1080–6.CrossRefPubMed
41.
AytekinB, UnalE, DemirA, AksuU, CaliskanA, VardarK, et al. Unilateral antegrade cerebral perfusion and moderate hypothermia: assessing safety with novel biomarkers. Heart Lung Circ. 2017;26(5):495–503.CrossRefPubMed
42.
IkonomidisJS. Current status of cerebral protection for aortic arch surgery. J Thoracic cardiovasc Surg. 2014;148(6):2466–7.CrossRef
43.
MisfeldM, MohrFW, EtzCD. Best strategy for cerebral protection in arch surgery—antegrade selective cerebral perfusion and adequate hypothermia. Ann Cardiothorac Surg. 2013;2:331–8.PubMedPubMedCentral
44.
HaglC, KhaladjN, KarckM, et al. Hypothermic circulatory arrest during ascending and aortic arch surgery: the theoretical impact of different cerebral perfusion techniques and other methods of cerebral protection. Eur J cardiothorac Surg. 2003;24:371–8.CrossRefPubMed
45.
UrbanskiPP, LenosA, BougioukakisP, et al. Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm?Eur J Cardiothoracic Surg. 2012;41:185–91.CrossRef
46.
HarrerM, WaldenbergerFR, WeissG, et al. Aortic arch surgery using bilateral antegrade selective cerebral perfusion in combination with near-infrared spectroscopy. Eur J Cardiothorac Surg. 2010;38:561–7.CrossRefPubMed
47.
AngeloniE, BenedettoU, TakkenbergJJ, et al. Unilateral versus bilateral antegrade cerebral protection during arrest in aortic surgery: a meta-analysis of 5100 patients. J Thorac Cardiovasc Surg2012.
48.
OkitaY, MinatoyaK, TagusariO, et al. Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg. 2001;72:72–9.22.CrossRefPubMed
49.
TanoueY, TominagaR, OchiaiY, et al. Comparative study of retrograde and selective cerebral perfusion with transcranial Doppler. Ann Thorac Surg. 1999;67:672–5.CrossRefPubMed
50.
SvenssonLG, BlackstoneEH, Apperson-HansenC, RuggieriPM, AinkaranP, NaugleRI, et al. Implications from neurologic assessment of brain protection for total arch replacement from a randomized trial. J Thorac Cardiovasc Surg. 2015;150(5):1140–7.e11.CrossRefPubMed
51.
SvenssonLG, NadolnyEM, PenneyDL, et al. Prospective randomized neurocognitive and S-100 study of hypothermic circulatory arrest, retrograde brain perfusion, and antegrade brain perfusion for aortic arch operations. Ann Thorac Surg. 2001;71:1905–12.CrossRefPubMed
52.
UsuiA, MiyataH, UedaY, et al. Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery: based on the Japan Adult Cardiovascular Surgery Database: the Japan Cardiovascular Surgery Database Organization. Gen Thorac Cardiovasc Surg. 2012;60:132–9.CrossRefPubMed
53.
FleckT, CzernyM, HutscalaD, KoinigH, WolnerE, GrabenwogerM. The incidence of transient neurologic dysfunction after aortic replacement with circulatory arrest. Ann Thorac Surg. 2003;76:1198–2002.CrossRefPubMed
54.
MuellerD, FueguthG, Wimmer-GreneckerG, et al. Neurologic outcome after surgery of the aortic arch: comparison of deep hypothermic arrest, antegrade and retrograde cerebral perfusion. J Thorac Cardiovasc Surg. 2004;20:72–6.CrossRef
55.
HaglC, ErginMA, GallaJD, LansmanSL, McCulloughJN, SpielvogelD, et al. Neurologic outcome after ascending aorta–aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg. 2001;121:1107–21.CrossRefPubMed
56.
NeriE, SassiC, BarabesiL, et al. Cerebral autoregulation after hypothermic circulatory arrest in operations on the aortic arch. Ann Thorac Surg. 2004;77:72–80.CrossRefPubMed
57.
HuZ, WangZ, RenZ, WuH, ZhangM, ZhangH, HuX. Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch surgery: a meta-analysis and systematic review of 5060 patients. J Thorac Cardiovasc Surg. 2014;148(2):544–60.CrossRefPubMed
58.
PerreasK, SamanidisG, ThanopoulosA, GeorgiopoulosG, AntoniouT, KhouryM, MichalisA, BairaktarisA. Antegrade or retrograde cerebral perfusion in ascending aorta and hemiarch surgery? a propensity-matched analysis. Ann Thorac Surg. 2016;101(1):146–52.CrossRefPubMed
59.
OkitaY, MiyataH, MotomuraN, TakamotoS, Japan Cardiovascular Surgery Database Organization. A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: analysis based on the Japan Adult Cardiovascular Surgery Database. J Thorac Cardiovasc Surg. 2015;149(2 Suppl):S65–73.CrossRefPubMed
60.
61.
ZiererA, El-Sayed AhmadA, PapadopoulosN, MoritzA, DiegelerA, UrbanskiPP. Selective antegrade cerebral perfusion and mild (28 °C–30 °C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients. J Thorac Cardiovasc Surg. 2012;144(5):1042–49.CrossRefPubMed
62.
ShihataM, MittalR, SenthilselvanA, RossD, KoshalA, MullenJ, MacArthurR. Selective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages. J Thorac Cardiovasc Surg. 2011 Apr;141(4):948 – 52.CrossRefPubMed
Metadaten
Titel
Brain protection in aortic arch aneurysm: antegrade or retrograde?
verfasst von
Amer Harky
Matthew Fok
Mohamad Bashir
Anthony L. Estrera
Publikationsdatum
03.01.2018
Verlag
Springer Japan
Erschienen in
General Thoracic and Cardiovascular Surgery / Ausgabe 1/2019
Print ISSN: 1863-6705
Elektronische ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-017-0879-5

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