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J Thorac Cardiovasc Surg 1994;107:788-799
© 1994 Mosby, Inc.
CARDIOPULMONARY BYPASS, |
New York, N.Y.
Address for reprints: M. Arisan Ergin, MD, The Mount Sinai Medical Center, Department of Cardiothoracic Surgery, One Gustave L. Levy Place, Box 1028, New York, NY 10029.
Abstract
This study was undertaken to determine the factors that influence the final outcome after hypothermic circulatory arrest. Between 1985 and 1992 a uniform method of hypothermic circulatory arrest was used in 200 patients as the primary method of cerebral protection during operations on aneurysms of the thoracic aorta. There were 30 hospital deaths (15%). Age greater than 60 years (relative risk 3.7, p < 0.02), emergency operation and hemodynamic compromise (relative risk 22.2, p < 0.000), concomitant procedures (relative risk 2.7, p < 0.04), presentation with new neurologic symptoms (relative risk 5.2, p < 0.04), and postoperative permanent neurologic deficits (relative risk 9.4, p < 0.000) were found to be significant predictors of operative mortality. A total of 183 patients were available for evaluation of neurologic function and outcome. Multivariate analysis of this cohort of patients by multiple logistic regression showed that temporary neurologic dysfunction occurred in 36 cases (19%). Temporary neurologic dysfunction correlated with the duration of hypothermic circulatory arrest (47 ± 16 minutes; odds ratio 1.06/minute; p < 0.001) and age (66 ± 14 years; odds ratio 1.07/year; p < 0.001). Embolic strokes occurred in 22 patients (11%) and were associated with permanent deficits in 13 (7%). Strokes correlated significantly with age (older than 60, 21% versus younger than 60, 1%; p < 0.001) and operations on the arch and descending aortic aneurysms containing clot or atheroma (p < 0.001). This experience shows that the operative mortality is not affected by any parameters related to the use of hypothermic circulatory arrest. The incidence of temporary neurologic dysfunction rises linearly in relation to the age of the patient and the duration of hypothermic circulatory arrest. However, permanent neurologic injury is a result of thromboembolic events and is not related to the method of cerebral protection used. Additional methods to prevent perioperative embolic strokes are needed. Hypothermic circulatory arrest affords adequate cerebral protection if the arrest period is kept less than 60 minutes. We will continue to use this modality until the safety and utility of the alternate methods of cerebral protection are shown to be superior. (J THORAC CARDIOVASC SURG 1994;107:788-99)
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D. L. Reich, S. Uysal, M. A. Ergin, and R. B. Griepp Retrograde cerebral perfusion as a method of neuroprotection during thoracic aortic surgery Ann. Thorac. Surg., November 1, 2001; 72(5): 1774 - 1782. [Abstract] [Full Text] [PDF]
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Y. Okita, K. Minatoya, O. Tagusari, M. Ando, K. Nagatsuka, and S. Kitamura 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., July 1, 2001; 72(1): 72 - 79. [Abstract] [Full Text] [PDF]
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T. Takahashi, Y. Shimazaki, T. Watanabe, T. Minowa, M. Koshika, K. Inui, J. Hosaka, and S. Toyama Staged perfusion with an axillary artery graft and deep hypothermia during descending aortic replacement J. Thorac. Cardiovasc. Surg., July 1, 2001; 122(1): 188 - 189. [Full Text] [PDF]
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L. G. Svensson, E. M. Nadolny, D. L. Penney, J. Jacobson, W. A. Kimmel, M. H. Entrup, and R. S. D'Agostino 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., June 1, 2001; 71(6): 1905 - 1912. [Abstract] [Full Text] [PDF]
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E. M. Nadolny and L. G. Svensson Hypothermic arrest for descending aortic rupture in reoperative patients Ann. Thorac. Surg., June 1, 2001; 71(6): 2027 - 2030. [Abstract] [Full Text] [PDF]
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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]
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D. L. Reich, S. Uysal, M. A. Ergin, C. A. Bodian, S. Hossain, and R. B. Griepp Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction Eur. J. Cardiothorac. Surg., May 1, 2001; 19(5): 594 - 600. [Abstract] [Full Text] [PDF]
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M. P. Ehrlich, J. McCullough, D. Wolfe, N. Zhang, H. Shiang, D. Weisz, C. Bodian, and R. B. Griepp Cerebral effects of cold reperfusion after hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., May 1, 2001; 121(5): 923 - 931. [Abstract] [Full Text] [PDF]
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C. Hagl, J. D. Galla, D. Spielvogel, S. L. Lansman, R. Squitieri, C. A. Bodian, M. A. Ergin, and R. B. Griepp Is aortic surgery using hypothermic circulatory arrest in octogenarians justifiable? Eur. J. Cardiothorac. Surg., April 1, 2001; 19(4): 417 - 423. [Abstract] [Full Text] [PDF]
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R. B. Griepp Cerebral protection during aortic arch surgery J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 425 - 427. [Full Text] [PDF]
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T. Kazui, N. Washiyama, B. A. H. Muhammad, H. Terada, K. Yamashita, and M. Takinami Improved results of atherosclerotic arch aneurysm operations with a refined technique J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 491 - 499. [Abstract] [Full Text] [PDF]
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Y. Moriyama, Y. Iguro, K. Hisatomi, G. Yotsumoto, H. Yamamoto, and R. Toda Thoracic and thoracoabdominal aneurysm repair under deep hypothermia using subclavian arterial perfusion Ann. Thorac. Surg., January 1, 2001; 71(1): 29 - 32. [Abstract] [Full Text] [PDF]
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R. Sinatra, G. Melina, I. Pulitani, B. Fiorani, G. Ruvolo, and B. Marino Emergency operation for acute type A aortic dissection: neurologic complications and early mortality Ann. Thorac. Surg., January 1, 2001; 71(1): 33 - 38. [Abstract] [Full Text] [PDF]
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T. Hirotani, T. Kameda, T. Kumamoto, and S. Shirota Aortic arch repair using hypothermic circulatory arrest technique associated with pharmacological brain protection Eur. J. Cardiothorac. Surg., November 1, 2000; 18(5): 545 - 549. [Abstract] [Full Text] [PDF]
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T. Ueda, H. Shimizu, T. Ito, I. Kashima, K. Hashizume, Y. Iino, and S. Kawada Cerebral complications associated with selective perfusion of the arch vessels Ann. Thorac. Surg., November 1, 2000; 70(5): 1472 - 1477. [Abstract] [Full Text] [PDF]
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T. Ueda, H. Shimizu, K. Moro, H. Shin, R. Yozu, I. Kashima, and S. Kawada Complications associated with clamping the aorta between the left common carotid artery and left subclavian artery Ann. Thorac. Surg., August 1, 2000; 70(2): 558 - 561. [Abstract] [Full Text] [PDF]
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R. Di Bartolomeo, D. Pacini, M. Di Eusanio, and A. Pierangeli Antegrade selective cerebral perfusion during operations on the thoracic aorta: our experience Ann. Thorac. Surg., July 1, 2000; 70(1): 10 - 15. [Abstract] [Full Text] [PDF]
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M. P. Ehrlich, M. A. Ergin, J. N. McCullough, S. L. Lansman, J. D. Galla, C. A. Bodian, A. Z. Apaydin, and R. B. Griepp Predictors of adverse outcome and transient neurological dysfunction after ascending aorta/hemiarch replacement Ann. Thorac. Surg., June 1, 2000; 69(6): 1755 - 1763. [Abstract] [Full Text] [PDF]
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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]
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T. Kazui, N. Washiyama, B. A. H. Muhammad, H. Terada, K. Yamashita, M. Takinami, and Y. Tamiya EXTENDED TOTAL ARCH REPLACEMENT FOR ACUTE TYPE A AORTIC DISSECTION: EXPERIENCE WITH SEVENTY PATIENTS J. Thorac. Cardiovasc. Surg., March 1, 2000; 119(3): 558 - 565. [Abstract] [Full Text] [PDF]
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M. Grabenwoger, D. Hutschala, M. P. Ehrlich, F. Cartes-Zumelzu, S. Thurnher, J. Lammer, E. Wolner, and M. Havel Thoracic aortic aneurysms: treatment with endovascular self-expandable stent grafts Ann. Thorac. Surg., February 1, 2000; 69(2): 441 - 445. [Abstract] [Full Text] [PDF]
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L. G. Svensson, A. Husain, D. L. Penney, R. A. Swanson, D. S. Margolis, W. A. Kimmel, E. Nadolny, and D. M. Shahian A PROSPECTIVE RANDOMIZED STUDY OF NEUROCOGNITIVE FUNCTION AND S-100 PROTEIN AFTER ANTEGRADE OR RETROGRADE BRAIN PERFUSION WITH HYPOTHERMIC ARREST FOR AORTIC SURGERY J. Thorac. Cardiovasc. Surg., January 1, 2000; 119(1): 163 - 167. [Full Text] [PDF]
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N. C. Poirier, G. S. Van Arsdell, M. Brindle, G. K. Thyagarajan, J. G. Coles, M. D. Black, R. M. Freedom, and W. G. Williams Surgical treatment of aortic arch hypoplasia in infants and children with biventricular hearts Ann. Thorac. Surg., December 1, 1999; 68(6): 2293 - 2297. [Abstract] [Full Text] [PDF]
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M. P. Ehrlich, W. C. Fang, M. Grabenwoger, A. Kocher, J. Ankersmit, G. Laufer, G. Grubhofer, M. Havel, and E. Wolner IMPACT OF RETROGRADE CEREBRAL PERFUSION ON AORTIC ARCH ANEURYSM REPAIR J. Thorac. Cardiovasc. Surg., December 1, 1999; 118(6): 1026 - 1032. [Abstract] [Full Text] [PDF]
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J. Ye, G. Dai, L. N. Ryner, P. Kozlowski, L. Yang, R. Summers, J. Sun, T. A. Salerno, R. L. Somorjai, and R. Deslauriers Unilateral Antegrade Cerebral Perfusion Through the Right Axillary Artery Provides Uniform Flow Distribution to Both Hemispheres of the Brain : A Magnetic Resonance and Histopathological Study in Pigs Circulation, November 9, 1999; 100 (2009): II-309 - II-315. [Abstract] [Full Text] [PDF]
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K. Inoue, H. Hosokawa, T. Iwase, M. Sato, Y. Yoshida, K. Ueno, A. Tsubokawa, T. Tanaka, S. Tamaki, and T. Suzuki Aortic Arch Reconstruction by Transluminally Placed Endovascular Branched Stent Graft Circulation, November 9, 1999; 100 (2009): II-316 - II-321. [Abstract] [Full Text] [PDF]
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B. H. Sirin, E. Coskun, L. Yilik, R. Ortac, H. Sirin, and C. Tetik Neuroprotective effects of preischemia subcutaneous magnesium sulfate in transient cerebral ischemia Eur. J. Cardiothorac. Surg., July 1, 1999; 14(1): 82 - 88. [Abstract] [Full Text] [PDF]
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C. R. Smith and T. B. Spanier Aprotinin in deep hypothermic circulatory arrest Ann. Thorac. Surg., July 1, 1999; 68(1): 278 - 286. [Abstract] [Full Text] [PDF]
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J. N. McCullough, N. Zhang, D. L. Reich, T. S. Juvonen, J. J. Klein, D. Spielvogel, M. A. Ergin, and R. B. Griepp Cerebral metabolic suppression during hypothermic circulatory arrest in humans Ann. Thorac. Surg., June 1, 1999; 67(6): 1895 - 1899. [Abstract] [Full Text] [PDF]
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