BACKGROUND: We have shown that selective antegrade cerebral perfusion improves mid-term quality of life in patients undergoing surgical repair for acute type A aortic dissection and aortic aneurysms. The aim of the study was to assess the impact of continuous cerebral perfusion through the right subclavian artery on immediate outcome and quality of life. METHODS: Perioperative data of 567 consecutive patients who underwent surgery of the aortic arch using deep hypothermic circulatory arrest have been analyzed. Patients were divided into three groups, according to the management of cerebral protection. Three hundred eighty-seven patients (68.3%) had deep hypothermic circulatory arrest with pharmacologic protection with pentothal only, 91 (16.0%) had selective antegrade cerebral perfusion and pentothal, and 89 (15.7%) had continuous cerebral perfusion through the right subclavian artery and pentothal. All in-hospital data were assessed, and quality of life was analyzed prospectively 2.4 +/- 1.2 years after surgery with the Short Form-36 Health Survey Questionnaire. RESULTS: Major perioperative cerebrovascular injuries were observed in 1.1% of the patients with continuous cerebral perfusion through the right subclavian artery, compared with 9.8% with selective antegrade cerebral perfusion (p < 0.001) and 6.5% in the group with no antegrade cerebral perfusion (p = 0.007). Average quality of life after an arrest time between 30 and 50 minutes with continuous cerebral perfusion through the right subclavian artery was significantly better than selective antegrade cerebral perfusion (90.2 +/- 12.1 versus 74.4 +/- 40.7; p = 0.015). CONCLUSIONS: Continuous cerebral perfusion through the right subclavian artery improves considerably perioperative brain protection during deep hypothermic circulatory arrest. Irreversible perioperative neurologic complications can be significantly reduced and duration of deep hypothermic circulatory arrest can be extended up to 50 minutes without impairment in quality of life.
BACKGROUND: We have shown that selective antegrade cerebral perfusion improves mid-term quality of life in patients undergoing surgical repair for acute type A aortic dissection and aortic aneurysms. The aim of the study was to assess the impact of continuous cerebral perfusion through the right subclavian artery on immediate outcome and quality of life. METHODS: Perioperative data of 567 consecutive patients who underwent surgery of the aortic arch using deep hypothermic circulatory arrest have been analyzed. Patients were divided into three groups, according to the management of cerebral protection. Three hundred eighty-seven patients (68.3%) had deep hypothermic circulatory arrest with pharmacologic protection with pentothal only, 91 (16.0%) had selective antegrade cerebral perfusion and pentothal, and 89 (15.7%) had continuous cerebral perfusion through the right subclavian artery and pentothal. All in-hospital data were assessed, and quality of life was analyzed prospectively 2.4 +/- 1.2 years after surgery with the Short Form-36 Health Survey Questionnaire. RESULTS: Major perioperative cerebrovascular injuries were observed in 1.1% of the patients with continuous cerebral perfusion through the right subclavian artery, compared with 9.8% with selective antegrade cerebral perfusion (p < 0.001) and 6.5% in the group with no antegrade cerebral perfusion (p = 0.007). Average quality of life after an arrest time between 30 and 50 minutes with continuous cerebral perfusion through the right subclavian artery was significantly better than selective antegrade cerebral perfusion (90.2 +/- 12.1 versus 74.4 +/- 40.7; p = 0.015). CONCLUSIONS: Continuous cerebral perfusion through the right subclavian artery improves considerably perioperative brain protection during deep hypothermic circulatory arrest. Irreversible perioperative neurologic complications can be significantly reduced and duration of deep hypothermic circulatory arrest can be extended up to 50 minutes without impairment in quality of life.
Authors: Sergey Leontyev; Martin Misfeld; Piroze Daviewala; Michael A Borger; Christian D Etz; Sergey Belaev; Joerg Seeburger; David Holzhey; Farhard Bakhtiary; Friedrich W Mohr Journal: Ann Cardiothorac Surg Date: 2013-09
Authors: L O Conzelmann; T Krüger; I Hoffmann; B Rylski; J Easo; M Oezkur; K Kallenbach; O Dapunt; M Karck; E Weigang Journal: Herz Date: 2011-09 Impact factor: 1.443
Authors: Sotiris C Stamou; Laura A Rausch; Nicholas T Kouchoukos; Kevin W Lobdell; Kamal Khabbaz; Edward Murphy; Robert C Hagberg Journal: Ann Cardiothorac Surg Date: 2016-07
Authors: Francesco Macrina; Paolo Emilio Puddu; Alfonso Sciangula; Fausto Trigilia; Marco Totaro; Fabio Miraldi; Francesca Toscano; Mauro Cassese; Michele Toscano Journal: Open Cardiovasc Med J Date: 2009-07-07
Authors: David H Tian; Benjamin Wan; Paul G Bannon; Martin Misfeld; Scott A LeMaire; Teruhisa Kazui; Nicholas T Kouchoukos; John A Elefteriades; Joseph E Bavaria; Joseph S Coselli; Randall B Griepp; Friedrich W Mohr; Aung Oo; Lars G Svensson; G Chad Hughes; Malcolm J Underwood; Edward P Chen; Thoralf M Sundt; Tristan D Yan Journal: Ann Cardiothorac Surg Date: 2013-05
Authors: Djordje Zdravkovic; Ivan Nesic; Igor Slavoljub Zivkovic; Marko Kaitovic; Petar Vukovic; Petar Milacic Journal: Kardiochir Torakochirurgia Pol Date: 2020-07-20
Authors: Radosław Gocoł; Damian Hudziak; Jarosław Bis; Konrad Mendrala; Łukasz Morkisz; Paweł Podsiadło; Sylweriusz Kosiński; Jacek Piątek; Tomasz Darocha Journal: Int J Environ Res Public Health Date: 2021-07-01 Impact factor: 3.390