Optimal Brain Protection in Aortic Arch Surgery

Overview

Journal Indian J Thorac Cardiovasc Surg

Publisher Springer

Date 2022 Apr 25

PMID 35463699

Authors

Parth Mukund Patel

Edward Po-Chung Chen

Affiliations

Soon will be listed here.

Abstract

There is considerable debate with regard to the optimal cerebral protection strategy during aortic arch surgery. There are three contemporary techniques in use which include straight deep hypothermic circulatory arrest (DHCA), DHCA with retrograde cerebral perfusion (DHCA + RCP), and moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA + ACP). Appropriate application of these methods ensures appropriate cerebral, myocardial, and visceral protection. Each of these techniques has benefits and drawbacks and ensuring coordinated circulation management strategy is critical to safe performance of aortic arch surgery. In this report, we will review various cannulation strategies, review logistics of hypothermia, and review the relevant literature to outline the strengths and weaknesses of these various cerebral protection strategies.

Citing Articles

Aortic versus axillary artery cannulation for hemiarch replacement: single-centre real-world experience.

Tel Ustunisik C, Yagci L, Arapi B, Balkanay O, Omeroglu S, Ipek G BMC Cardiovasc Disord. 2024; 24(1):462.

PMID: 39198748 PMC: 11351082. DOI: 10.1186/s12872-024-04125-1.

References

Lemole G, Strong M, SPAGNA P, Karmilowicz N . Improved results for dissecting aneurysms. Intraluminal sutureless prosthesis. J Thorac Cardiovasc Surg. 1982; 83(2):249-55. View

Cooley D, MAHAFFEY D, DE BAKEY M . Total excision of the aortic arch for aneurysm. Surg Gynecol Obstet. 1955; 101(6):667-72. View

Armstead W . Cerebral Blood Flow Autoregulation and Dysautoregulation. Anesthesiol Clin. 2016; 34(3):465-77. PMC: 4988341. DOI: 10.1016/j.anclin.2016.04.002. View

De Paulis R, Czerny M, Weltert L, Bavaria J, Borger M, Carrel T . Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe. Eur J Cardiothorac Surg. 2014; 47(5):917-23. DOI: 10.1093/ejcts/ezu284. View

Bachet J, Guilmet D, Goudot B, Termignon J, Teodori G, Dreyfus G . Cold cerebroplegia. A new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg. 1991; 102(1):85-93; discussion 93-4. View

Urbanski P, Thamm T, Bougioukakis P, Irimie V, Pravin Prasad , Diegeler A . Efficacy of unilateral cerebral perfusion for brain protection in aortic arch surgery. J Thorac Cardiovasc Surg. 2019; 159(2):365-371.e1. DOI: 10.1016/j.jtcvs.2019.02.039. View

Hameed I, Rahouma M, Khan F, Wingo M, Demetres M, Tam D . Cerebral protection strategies in aortic arch surgery: A network meta-analysis. J Thorac Cardiovasc Surg. 2019; 159(1):18-31. DOI: 10.1016/j.jtcvs.2019.02.045. View

Ergin M, Galla J, Lansman S, Quintana C, Bodian C, Griepp R . Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg. 1994; 107(3):788-97; discussion 797-9. View

Zwerus R, Absalom A . Update on anesthetic neuroprotection. Curr Opin Anaesthesiol. 2015; 28(4):424-30. DOI: 10.1097/ACO.0000000000000212. View

10.

Magner J . Complications of aortic cannulation for open-heart surgery. Thorax. 1971; 26(2):172-3. PMC: 1019122. DOI: 10.1136/thx.26.2.172. View

11.

Deng J, Lei C, Chen Y, Fang Z, Yang Q, Zhang H . Neuroprotective gases--fantasy or reality for clinical use?. Prog Neurobiol. 2014; 115:210-45. DOI: 10.1016/j.pneurobio.2014.01.001. View

12.

Khaladj N, Shrestha M, Peterss S, Strueber M, Karck M, Pichlmaier M . Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. Eur J Cardiothorac Surg. 2008; 34(4):792-6. DOI: 10.1016/j.ejcts.2008.05.014. View

13.

Wong D, Coselli J, Palmero L, Bozinovski J, Carter S, Murariu D . Axillary artery cannulation in surgery for acute or subacute ascending aortic dissections. Ann Thorac Surg. 2010; 90(3):731-7. DOI: 10.1016/j.athoracsur.2010.04.059. View

14.

Bilotta F, Gelb A, Stazi E, Titi L, Paoloni F, Rosa G . Pharmacological perioperative brain neuroprotection: a qualitative review of randomized clinical trials. Br J Anaesth. 2013; 110 Suppl 1:i113-20. DOI: 10.1093/bja/aet059. View

15.

Ahmad A, Papadopoulos N, Risteski P, Moritz A, Zierer A . The Standardized Concept of Moderate-to-Mild (≥28°C) Systemic Hypothermia During Selective Antegrade Cerebral Perfusion for All-Comers in Aortic Arch Surgery: Single-Center Experience in 587 Consecutive Patients Over a 15-Year Period. Ann Thorac Surg. 2017; 104(1):49-55. DOI: 10.1016/j.athoracsur.2016.10.024. View

16.

Ayyash B, Tranquilli M, Elefteriades J . Femoral artery cannulation for thoracic aortic surgery: safe under transesophageal echocardiographic control. J Thorac Cardiovasc Surg. 2011; 142(6):1478-81. DOI: 10.1016/j.jtcvs.2011.04.005. View

17.

Griepp R, Stinson E, Hollingsworth J, Buehler D . Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975; 70(6):1051-63. View

18.

Livesay J, Cooley D, Reul G, Walker W, Frazier O, Duncan J . Resection of aortic arch aneurysms: a comparison of hypothermic techniques in 60 patients. Ann Thorac Surg. 1983; 36(1):19-28. DOI: 10.1016/s0003-4975(10)60643-1. View

19.

LEWIS F, TAUFIC M . Closure of atrial septal defects with the aid of hypothermia; experimental accomplishments and the report of one successful case. Surgery. 1953; 33(1):52-9. View

20.

Reece T, Tribble C, Smith R, Singh R, Stiles B, Peeler B . Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg. 2007; 133(2):428-34. DOI: 10.1016/j.jtcvs.2006.09.059. View