| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Ann Thorac Surg 1999;67:1904-1910
© 1999 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
b Department of Anesthesiology, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
Address correspondence to Dr Dossche, Department of Cardiothoracic Surgery, St. Antonius Ziekenhuis, Koekoekslaan 1, 3435 CM Nieuwegein, the Netherlands
Presented at the Aortic Surgery Symposium VI, April 30–May 1, 1998, New York, NY.
Background. To determine the factors that influence hospital death and neurologic complications after surgery on the thoracic aorta using circulatory arrest and antegrade selective cerebral perfusion.
Methods. From May 1989 through April 1997, 106 patients underwent surgery on the thoracic aorta using circulatory arrest and antegrade selective cerebral perfusion. Mean age was 64.0 ± 11.5 years. Unilateral antegrade cerebral perfusion was used in 37 patients (35%), bihemispheric antegrade cerebral perfusion in 69 patients (65%). Mean antegrade cerebral perfusion time was 50.5 ± 20.5 minutes. Indication for surgery was atherosclerotic aneurysm in 60 (56.5%) patients, postdissection aneurysm in 26 (24.4%), acute type A dissection in 16 (15.1%), other in 4 (4.0%).
Results. Hospital mortality was 8.5% (n = 9; 70% CL: 5.8%–11.2%). Independent predictors of hospital mortality were rethoracotomy (odds ratio 5.7, p = 0.02), postoperative temporary (odds ratio 17.3, p = 0.02) or permanent (odds ratio 7.5, p = 0.03) neurologic dysfunction, postoperative dialysis (odds ratio 9.9, p = 0.008). Bilateral antegrade selective cerebral perfusion had a favorable impact on hospital mortality (odds ratio 0.08, p = 0.007). Temporary neurologic dysfunction occurred in 3.8% of patients (n = 4; 70% CL: 2.0%–5.6%); preoperative hemodynamic instability (odds ratio 14.8, p = 0.05) and perioperative technical problems (odds ratio 22.2, p = 0.033) were independent determinants of temporary neurologic dysfunction. Permanent central neurologic damage occurred in 5.4% of patients (n = 6; 70% CL: 3.2%–7.6%). Preoperative hemodynamic instability (odds ratio 18.9, p = 0.009) and approach through a left thoracotomy (odds ratio 9.4, p = 0.031) were significant predictors of permanent neurologic damage.
Conclusions. Hospital mortality is affected significantly by the choice of technique used for antegrade cerebral perfusion. The incidence of both temporary and permanent postoperative central neurologic damage is influenced by preoperative hemodynamic instability. Duration of cerebral perfusion had no influence on the postoperative neurologic outcome.
This article has been cited by other articles:
|
|
 |
|
  J. W. Hammon Extracorporeal Circulation: Perfusion System Card. Surg. Adult, January 1, 2008; 3(2008): 350 - 370. [Full Text]
|
|
|
|
 |
|
 M. Asano, K. Okada, K. Nakagiri, H. Tanaka, Y. Kawanishi, M. Matsumori, H. Munakata, and Y. Okita Total arch replacement for aneurysm of the aortic arch: factors influencing the distal anastomosis Interactive CardioVascular and Thoracic Surgery, June 1, 2007; 6(3): 283 - 287. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Gulbins, A. Pritisanac, and J. Ennker Axillary Versus Femoral Cannulation for Aortic Surgery: Enough Evidence for a General Recommendation? Ann. Thorac. Surg., March 1, 2007; 83(3): 1219 - 1224. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A.A.M. Schepens Aortic arch replacement: the conventional 'elephant trunk' technique MMCTS, January 2, 2007; 2007(0102): 2006. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Olsson and S. Thelin Antegrade Cerebral Perfusion With a Simplified Technique: Unilateral Versus Bilateral Perfusion. Ann. Thorac. Surg., March 1, 2006; 81(3): 868 - 874. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. S.H. Tan, W. J. Morshuis, K. M.E. Dossche, J. C. Kelder, F. G.J. Waanders, and M. A.A.M. Schepens Long-Term Results After 27 Years of Surgical Treatment of Acute Type A Aortic Dissection Ann. Thorac. Surg., August 1, 2005; 80(2): 523 - 529. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Kucuker, M. A. Ozatik, A. Saritas, and O. Tasdemir Arch repair with unilateral antegrade cerebral perfusion Eur. J. Cardiothorac. Surg., April 1, 2005; 27(4): 638 - 643. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Ohkura, T. Kazui, S. Yamamoto, K. Yamashita, H. Terada, N. Washiyama, T. Suzuki, K. Suzuki, M. Fujie, and K. Ohishi Comparison of pH management during antegrade selective cerebral perfusion in canine models with old cerebral infarction J. Thorac. Cardiovasc. Surg., September 1, 2004; 128(3): 378 - 385. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. T. Kouchoukos and P. Masetti Total aortic arch replacement with a branched graft and limited circulatory arrest of the brain J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 233 - 237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Di Eusanio, M. A. A. M. Schepens, W. J. Morshuis, K. M. Dossche, T. Kazui, K. Ohkura, N. Washiyama, R. Di Bartolomeo, D. Pacini, and A. Pierangeli Separate grafts or en bloc anastomosis for arch vessels reimplantation to the aortic arch Ann. Thorac. Surg., June 1, 2004; 77(6): 2021 - 2028. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Melissano, F. Maisano, E. Civilini, O. Alfieri, and R. Chiesa Direct cerebral perfusion and myocardial protection with moderate systemic hypothermic arrest for high descending aortic aneurysm J. Thorac. Cardiovasc. Surg., May 1, 2004; 127(5): 1530 - 1531. [Full Text] [PDF]
|
|
|
|
|
|
M. Di Eusanio, M. A.A.M. Schepens, W. J. Morshuis, K. M. Dossche, R. Di Bartolomeo, D. Pacini, A. Pierangeli, T. Kazui, K. Ohkura, and N. Washiyama Brain protection using antegrade selective cerebral perfusion: a multicenter study Ann. Thorac. Surg., October 1, 2003; 76(4): 1181 - 1189. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Fleck, M. Czerny, D. Hutschala, H. Koinig, E. Wolner, and M. Grabenwoger The incidence of transient neurologic dysfunction after ascending aortic replacement with circulatory arrest Ann. Thorac. Surg., October 1, 2003; 76(4): 1198 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. S. H. Tan, K. M. E. Dossche, W. J. Morshuis, J. C. Kelder, F. G. J. Waanders, and M. A.A.M. Schepens Is extended arch replacement for acute Type A aortic dissection an additional risk factor for mortality? Ann. Thorac. Surg., October 1, 2003; 76(4): 1209 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hagl, J. D. Galla, D. Spielvogel, C. Bodian, S. L. Lansman, R. Squitieri, M. A. Ergin, and R. B. Griepp Diabetes and evidence of atherosclerosis are major risk factors for adverse outcome after elective thoracic aortic surgery J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1005 - 1012. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hagl, N. Khaladj, M. Karck, K. Kallenbach, R. Leyh, M. Winterhalter, and A. Haverich 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., September 1, 2003; 24(3): 371 - 378. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Kawachi, A. Nakashima, Y. Toshima, T. Kosuga, K. Imasaka, and H. Tomoeda Stroke in Thoracic Aortic Surgery: Outcome and Risk Factors Asian Cardiovasc Thorac Ann, March 1, 2003; 11(1): 52 - 57. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Di Eusanio, M. E. S.H. Tan, M. A.A.M. Schepens, K. M. Dossche, R. Di Bartolomeo, A. Pierangeli, and W. J. Morshuis Surgery for acute type A dissection using antegrade selective cerebral perfusion: experience with 122 patients Ann. Thorac. Surg., February 1, 2003; 75(2): 514 - 519. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. A. Hessel II and L. H. Edmunds Jr. Extracorporeal Circulation: Perfusion Systems Card. Surg. Adult, January 1, 2003; 2(2003): 317 - 338. [Full Text]
|
|
|
|
|
|
M. Di Eusanio, M. A. A. M. Schepens, W. J. Morshuis, R. Di Bartolomeo, A. Pierangeli, and K. M. Dossche Antegrade selective cerebral perfusion during operations on the thoracic aorta: Factors influencing survival and neurologic outcome in 413 patients J. Thorac. Cardiovasc. Surg., December 1, 2002; 124(6): 1080 - 1086. [Abstract] [Full Text]
|
|
|
|
|
|
T. Kazui, K. Yamashita, N. Washiyama, H. Terada, A. H. M. Bashar, T. Suzuki, and K. Ohkura Usefulness of antegrade selective cerebral perfusion during aortic arch operations Ann. Thorac. Surg., November 1, 2002; 74(5): S1806 - 1809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Tasdemir, A. Saritas, S. Kucuker, M. A. Ozatik, and E. Sener Aortic arch repair with right brachial artery perfusion Ann. Thorac. Surg., June 1, 2002; 73(6): 1837 - 1842. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. A. Schepens, K. M. Dossche, W. J. Morshuis, P. J. van den Barselaar, R. H. Heijmen, and F. E. Vermeulen The elephant trunk technique: operative results in 100 consecutive patients Eur. J. Cardiothorac. Surg., February 1, 2002; 21(2): 276 - 281. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Bednarkiewicz, G. Khatchatourian, J.T. Christenson, and B. Faidutti Aortic arch replacement using a four-branched aortic arch graft Eur. J. Cardiothorac. Surg., January 1, 2002; 21(1): 89 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. E. S.H. Tan, J. C. Kelder, W. J. Morshuis, and M. A.A.M. Schepens Risk stratification in acute type A dissection: proposition for a new scoring system Ann. Thorac. Surg., December 1, 2001; 72(6): 2065 - 2069. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Washiyama, T. Kazui, M. Takinami, K. Yamashita, S. Fujita, H. Terada, K. Suzuki, B. A. H. Muhammad, M. Fujie, and S. Yamamoto Experimental study on the effect of antegrade cerebral perfusion on brains with old cerebral infarction J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 734 - 740. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Hagl, M. A. Ergin, J. D. Galla, S. L. Lansman, J. N. McCullough, D. Spielvogel, P. Sfeir, C. A. Bodian, and R. B. Griepp Neurologic outcome after ascending aorta-aortic arch operations: Effect of brain protection technique in high-risk patients J. Thorac. Cardiovasc. Surg., June 1, 2001; 121(6): 1107 - 1121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ogino, Y. Ueda, T. Sugita, K. Matsuyama, K. Matsubayashi, T. Nomoto, and T. Yoshioka Aortic arch repairs through three different approaches Eur. J. Cardiothorac. Surg., January 1, 2001; 19(1): 25 - 29. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. P. Casselman, M. E. S.H. Tan, F. E.E. Vermeulen, J. C. Kelder, W. J. Morshuis, and M. A.A.M. Schepens Durability of aortic valve preservation and root reconstruction in acute type A aortic dissection Ann. Thorac. Surg., October 1, 2000; 70(4): 1227 - 1233. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Dossche, W. J. Morshuis, M. A. Schepens, and F. G. Waanders Bilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 462 - 467. [Abstract] [Full Text] [PDF]
|
|
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| ANN THORAC SURG | ASIAN CARDIOVASC THORAC ANN | EUR J CARDIOTHORAC SURG |
| J THORAC CARDIOVASC SURG | ICVTS | ALL CTSNet JOURNALS |
