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Erschienen in: Heart and Vessels 1/2018

23.08.2017 | Original Article

Randomized controlled trial of moderate hypothermia versus deep hypothermia anesthesia on brain injury during Stanford A aortic dissection surgery

verfasst von: Xufang Sun, Hua Yang, Xinyu Li, Yue Wang, Chuncheng Zhang, Zhimin Song, Zhenxiang Pan

Erschienen in: Heart and Vessels | Ausgabe 1/2018

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Abstract

This study aimed to compare the effects of moderate versus deep hypothermia anesthesia for Stanford A aortic dissection surgery on brain injury. A total of 82 patients who would undergo Stanford A aortic dissection surgery were randomized into two groups: moderate hypothermia group (MH, n = 40, nasopharyngeal temperature 25 °C, and rectal temperature 28 °C) and deep hypothermia group (DH, n = 42, nasopharyngeal temperature 20 °C, and rectal temperature 25 °C). Different vascular replacement techniques including aortic root replacement, Bentall, and Wheat were used. The intraoperative and postoperative indicators of these patients were recorded. There were no differences in intraoperative and postoperative measures between MH and DH groups. The concentrations of neuron-specific enolase and S-100β increased with operation time, and were significantly lower in MH group than those in the DH group (P < 0.05). The occurrence rates of complications including chenosis, postoperative agitation, and neurological complications in MH group were significantly lower than in DH group. The recovery time, postoperative tube, and ICU intubation stay were significantly shorter in MH group than those in DH group (P < 0.05). There were no significant differences revealed in hospital stay and death rate. MH exhibited better cerebral protective effects, less complications, and shorter tube time than DH in surgery for Stanford A aortic dissection.
Literatur
1.
Zurück zum Zitat David TE (1999) Surgery for acute type A aortic dissection. Oper Tech Thorac Cardiovasc Surg 4(1):2–12CrossRef David TE (1999) Surgery for acute type A aortic dissection. Oper Tech Thorac Cardiovasc Surg 4(1):2–12CrossRef
2.
Zurück zum Zitat Zizza A, Pano M, Zaccaria S, Villani M, Guido M, Group ADS (2009) Outcome of acute type A aortic dissection: single-center experience from 1998 to 2007. J Prev Med Hyg 50(3):152–158PubMed Zizza A, Pano M, Zaccaria S, Villani M, Guido M, Group ADS (2009) Outcome of acute type A aortic dissection: single-center experience from 1998 to 2007. J Prev Med Hyg 50(3):152–158PubMed
3.
Zurück zum Zitat Rodriguez-Blanco YF, Garcia L, Brice T, Ricci M, Salerno TA (2012) Deep hypothermic circulatory arrest with lung perfusion/ventilation in a patient with acute type a aortic dissection. Case Rep Med 2012:631494CrossRefPubMedPubMedCentral Rodriguez-Blanco YF, Garcia L, Brice T, Ricci M, Salerno TA (2012) Deep hypothermic circulatory arrest with lung perfusion/ventilation in a patient with acute type a aortic dissection. Case Rep Med 2012:631494CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Manapat AE, Garcia JM, Barril JB, Lopez GA, Talavera DA (1998) Repair of thoracic aortic aneurysm and dissection using deep-hypothermic circulatory arrest. Asian Cardiovasc Thorac Ann 6(6):95–100CrossRef Manapat AE, Garcia JM, Barril JB, Lopez GA, Talavera DA (1998) Repair of thoracic aortic aneurysm and dissection using deep-hypothermic circulatory arrest. Asian Cardiovasc Thorac Ann 6(6):95–100CrossRef
5.
Zurück zum Zitat Ehrlich M, Grabenwöger M, Simon P, Laufer G, Wolner E, Havel M (1995) Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest. Tex Heart Inst J 22(3):250–253 (discussion 253–254) PubMedPubMedCentral Ehrlich M, Grabenwöger M, Simon P, Laufer G, Wolner E, Havel M (1995) Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest. Tex Heart Inst J 22(3):250–253 (discussion 253–254) PubMedPubMedCentral
6.
Zurück zum Zitat Moon MR, Miller DC (1999) Aortic arch replacement for dissection. Oper Tech Thorac Cardiovasc Surg 4(1):33–57CrossRef Moon MR, Miller DC (1999) Aortic arch replacement for dissection. Oper Tech Thorac Cardiovasc Surg 4(1):33–57CrossRef
7.
Zurück zum Zitat Algarni KD, Yanagawa B, Rao V, Yau TM (2014) Profound hypothermia compared with moderate hypothermia inrepair of acute type A aortic dissection. J Thorac Cardiovasc Surg 148(6):2888–2894CrossRefPubMed Algarni KD, Yanagawa B, Rao V, Yau TM (2014) Profound hypothermia compared with moderate hypothermia inrepair of acute type A aortic dissection. J Thorac Cardiovasc Surg 148(6):2888–2894CrossRefPubMed
8.
Zurück zum Zitat Leshnower BG, Thourani VH, Halkos ME, Sarin EL, Keeling WB, Lamias MJ, Guyton RA, Chen EP (2015) Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection. Ann Thorac Med 100(5):1563–1569CrossRef Leshnower BG, Thourani VH, Halkos ME, Sarin EL, Keeling WB, Lamias MJ, Guyton RA, Chen EP (2015) Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection. Ann Thorac Med 100(5):1563–1569CrossRef
9.
Zurück zum Zitat Xu CE, Zou CW, Zhang MY, Guo L (2013) Effects of high-dose ulinastatin on inflammatory response and pulmonary function in patients with type-A aortic dissection after cardiopulmonary bypass under deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth 27(3):479–484CrossRefPubMed Xu CE, Zou CW, Zhang MY, Guo L (2013) Effects of high-dose ulinastatin on inflammatory response and pulmonary function in patients with type-A aortic dissection after cardiopulmonary bypass under deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth 27(3):479–484CrossRefPubMed
10.
Zurück zum Zitat Kim JH, Na CY, Oh SS, Lee CH, Baek MJ, Hwang SW, Lee C, Lim HG (2006) Risk factor analysis for operative death and brain injury after surgery of stanford type A aortic dissection. Korean J Thorac Cardiovasc Surg 39(4):289–297 Kim JH, Na CY, Oh SS, Lee CH, Baek MJ, Hwang SW, Lee C, Lim HG (2006) Risk factor analysis for operative death and brain injury after surgery of stanford type A aortic dissection. Korean J Thorac Cardiovasc Surg 39(4):289–297
11.
Zurück zum Zitat Zierer A, Aybek T, Risteski P, Dogan S, Wimmergreinecker G, Moritz A (2005) Moderate hypothermia (30 degrees C) for surgery of acute type A aortic dissection. Thorac Cardiovasc Surg 53(2):74–79CrossRefPubMed Zierer A, Aybek T, Risteski P, Dogan S, Wimmergreinecker G, Moritz A (2005) Moderate hypothermia (30 degrees C) for surgery of acute type A aortic dissection. Thorac Cardiovasc Surg 53(2):74–79CrossRefPubMed
12.
Zurück zum Zitat Wang Y (2014) Variable selection, response adaptive randomization, and covariate-adjusted response-adaptive randomization for personalized medicine. Dissertations & Theses, Gradworks Wang Y (2014) Variable selection, response adaptive randomization, and covariate-adjusted response-adaptive randomization for personalized medicine. Dissertations & Theses, Gradworks
13.
Zurück zum Zitat Calderon L, Callaway C, Guyette F, Doshi A, Rittenberger J (2012) 535: NSE and S-100B as prognostic biomarkers of neurological injury and survival following resuscitation from cardiac arrest. Crit Care Med 40(12):1–328CrossRef Calderon L, Callaway C, Guyette F, Doshi A, Rittenberger J (2012) 535: NSE and S-100B as prognostic biomarkers of neurological injury and survival following resuscitation from cardiac arrest. Crit Care Med 40(12):1–328CrossRef
14.
Zurück zum Zitat Graham JM, Stinnett DM (1987) Operative management of acute aortic arch dissection using profound hypothermia and circulatory arrest. Ann Thorac Surg 44(2):192–198CrossRefPubMed Graham JM, Stinnett DM (1987) Operative management of acute aortic arch dissection using profound hypothermia and circulatory arrest. Ann Thorac Surg 44(2):192–198CrossRefPubMed
16.
Zurück zum Zitat Parissis H, Hamid U, Soo A, Alalao B (2010) Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool? J Cardiothorac Surg 6(1):153CrossRef Parissis H, Hamid U, Soo A, Alalao B (2010) Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool? J Cardiothorac Surg 6(1):153CrossRef
17.
Zurück zum Zitat Aebert H, Brawanski A, Philipp A, Behr R, Ullrich OW, Keyl C, Birnbaum DE (1998) Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms. Eur J Cardiothorac Surg 13(3):223–229CrossRefPubMed Aebert H, Brawanski A, Philipp A, Behr R, Ullrich OW, Keyl C, Birnbaum DE (1998) Deep hypothermia and circulatory arrest for surgery of complex intracranial aneurysms. Eur J Cardiothorac Surg 13(3):223–229CrossRefPubMed
18.
Zurück zum Zitat Comas GM, Leshnower BG, Halkos ME, Thourani VH, Puskas JD, Guyton RA, Kilgo PD, Chen EP (2013) Acute type A dissection: impact of antegrade cerebral perfusion under moderate hypothermia. Ann Thorac Surg 96(6):2135–2141CrossRefPubMed Comas GM, Leshnower BG, Halkos ME, Thourani VH, Puskas JD, Guyton RA, Kilgo PD, Chen EP (2013) Acute type A dissection: impact of antegrade cerebral perfusion under moderate hypothermia. Ann Thorac Surg 96(6):2135–2141CrossRefPubMed
19.
Zurück zum Zitat Olivecrona M, Rodlingwahlström M, Naredi S, Koskinen LD (2008) S-100B and NSE are poor outcome predictors in severe traumatic brain injury treated by an ICP targeted therapy. J Neurol Neurosurg Psychiatry 80(11):1241–1247CrossRef Olivecrona M, Rodlingwahlström M, Naredi S, Koskinen LD (2008) S-100B and NSE are poor outcome predictors in severe traumatic brain injury treated by an ICP targeted therapy. J Neurol Neurosurg Psychiatry 80(11):1241–1247CrossRef
20.
Zurück zum Zitat Pleines UE, Morganti-Kossmann MC, Rancan M, Joller H, Trentz O, Kossmann T (2001) S-100 beta reflects the extent of injury and outcome, whereas neuronal specific enolase is a better indicator of neuroinflammation in patients with severe traumatic brain injury. J Neurotrauma 18(5):491–498CrossRefPubMed Pleines UE, Morganti-Kossmann MC, Rancan M, Joller H, Trentz O, Kossmann T (2001) S-100 beta reflects the extent of injury and outcome, whereas neuronal specific enolase is a better indicator of neuroinflammation in patients with severe traumatic brain injury. J Neurotrauma 18(5):491–498CrossRefPubMed
21.
Zurück zum Zitat Xiang JJ, Wang P, Ben-Fu XU, Pediatrics DO (2014) Early diagnosis value of NSE and serum S-100 protein in cerebral injury of preterm infant. China Pract Med 28:54–55 Xiang JJ, Wang P, Ben-Fu XU, Pediatrics DO (2014) Early diagnosis value of NSE and serum S-100 protein in cerebral injury of preterm infant. China Pract Med 28:54–55
22.
Zurück zum Zitat Schulte K, Rizwan A (2014) State-of-the-art blood conservation strategies following repair of aortic aneurysms and acute aortic dissection. Curr res cardiol 1(1):17–22CrossRef Schulte K, Rizwan A (2014) State-of-the-art blood conservation strategies following repair of aortic aneurysms and acute aortic dissection. Curr res cardiol 1(1):17–22CrossRef
23.
Zurück zum Zitat Papalexopoulou N, Attia RQ, Bapat VN (2013) Successful surgical repair of acute type A aortic dissection without the use of blood products. Ann R Coll Surg Engl 95(7):127–129CrossRefPubMed Papalexopoulou N, Attia RQ, Bapat VN (2013) Successful surgical repair of acute type A aortic dissection without the use of blood products. Ann R Coll Surg Engl 95(7):127–129CrossRefPubMed
Metadaten
Titel
Randomized controlled trial of moderate hypothermia versus deep hypothermia anesthesia on brain injury during Stanford A aortic dissection surgery
verfasst von
Xufang Sun
Hua Yang
Xinyu Li
Yue Wang
Chuncheng Zhang
Zhimin Song
Zhenxiang Pan
Publikationsdatum
23.08.2017
Verlag
Springer Japan
Erschienen in
Heart and Vessels / Ausgabe 1/2018
Print ISSN: 0910-8327
Elektronische ISSN: 1615-2573
DOI
https://doi.org/10.1007/s00380-017-1037-9

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