| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
J Thorac Cardiovasc Surg 2001;121:491-499
© 2001 The American Association for Thoracic Surgery
Surgery for Acquired Cardiovascular Disease |
From the First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Received for publication Aug 2, 2000. Accepted for publication Oct 20, 2000. Address for reprints: Teruhisa Kazui, MD, First Department of Surgery, Hamamatsu University School of Medicine, 3600 HANDA-CHO, Hamamatsu, Japan, 431-3192 (E-mail: surg1ss{at}hama-med.ac.jp).
 |
Abstract |
|---|
 Top Abstract IntroductionMaterial and methodsResultsDiscussionReferences |
|---|
|
Introduction |
|---|
|
TopAbstractIntroductionMaterial and methodsResultsDiscussionReferences |
|---|
With recent improvement in surgical technique of aortic arch reconstruction and cerebral protection methods during aortic arch repair, outcomes of aortic arch aneurysm operations have remarkably improved. However, mortality and morbidities, including neurologic dysfunction, in patients who undergo aortic arch repair for atherosclerotic aneurysms remain high because of advanced age and comorbidities.
1-4 In our previous experience with 220 patients who underwent aortic arch operations for various indications, including atherosclerotic arch aneurysm (100 patients), the in-hospital mortality was 12.7%, and the postoperative permanent and temporary neurologic dysfunctions were 3.3% and 6%, respectively. 5
The purpose of the present study was to evaluate whether our recent refined technique was able to reduce the in-hospital mortality and postoperative neurologic dysfunction in this particular group of patients.
|
Material and methods |
|---|
|
TopAbstractIntroductionMaterial and methodsResultsDiscussionReferences |
|---|
Preoperative comorbidities included coronary artery disease in 11 (22%) patients; chronic obstructive pulmonary disease in 6 (12%) patients; aortic valvular disease in 3 (6%) patients; history of cerebrovascular disease in 9 (18%) patients, including old cerebral infarct in 6 (12%) patients; chronic renal failure in 4 (8%) patients, with 2 requiring hemodialysis; abdominal aortic aneurysm in 3 (6%) patients; aortoiliac occlusive disease in 1 (2%) patient; hypertension in 26 (56%) patients; and diabetes mellitus in 2 (4%) patients. Six (12%) patients had previous operations, including aortoiliac graft replacement for abdominal aortic aneurysm in 5 (10%) patients and descending aortic graft replacement for descending aortic aneurysm in 1 (2%) patient. Another 3 (6%) patients had previous percutaneous transluminal coronary angioplasty for coronary artery disease.
Preoperative aortography or digital subtraction angiography, including cerebral 4-vessel angiography, and cerebral computed tomography were performed in all patients undergoing elective procedures.
Operative technique
All operations were performed through a median sternotomy, with an extension of the incision to the left supraclavicular region. Table I summarizes the extent of the operative procedure done in this series. The details of hypothermic CPB and antegrade SCP have been described previously. 6,7 During CPB, arterial blood pH was managed according to the alpha-stat strategy. As for the site of arterial cannulation for CPB, the ascending aorta was selected in the recent 34 (68%) patients, whereas the femoral artery was selected in the remaining 16 (32%) patients. Before the ascending aorta was cannulated, epiaortic ultrasonography scanning and transesophageal echocardiography were routinely performed to assess whether atherosclerotic plaques are present in the ascending aorta and the aortic arch.
|
Real-time intraoperative monitoring of SCP is important to assess whether cerebral perfusion is adequate. First, we monitor the perfusion pressure and flow rate of SCP. For the perfusion pressure of SCP, the right radial artery pressure and the bilateral catheter tip pressure are routinely monitored. Two-channel serial electroencephalography to monitor the cerebral electrical activity and 2-channel near infrared spectroscopy (Hamamatsu Photonix, Hamamatsu, Japan) to estimate regional cerebral oxygenation are used. These techniques also assess discrepancies of cerebral circulation between the 2 cerebral hemispheres. In addition to these, internal jugular venous oxygen saturation is used to monitor cerebral oxygen consumption.
Vascular prostheses used in all patients were commercially available collagen-pretreated aortic arch grafts with 4 limbs (Hemashield Branched Graft; Meadox Medical, Oakland, NJ). The details of our recent technique of total arch replacement with an aortic arch branched graft for atherosclerotic aneurysm of the aortic arch are depicted inFig 1. Under SCP with systemic circulatory arrest at a rectal temperature of 22°C, the descending aorta just below the aneurysm is completely transected(Fig 1, B). The distal side of the arch graft with 4 limbs is anastomosed to the stump of the descending aorta by a 4-0 monofilament running suture with Teflon felt reinforcement(Fig 1, C). The arch graft proximal to the fourth limb is crossclamped, and systemic perfusion to the lower half of the body is started from the fourth limb of the arch graft(Fig 1, D). The third limb is then anastomosed to the left subclavian artery by a 5-0 monofilament running suture. Then the arch graft proximal to the third limb is crossclamped, and rewarming by means of CPB is started(Fig 1, E). The proximal side of the arch graft is sutured to the stump of the ascending aorta by a 4-0 monofilament running suture with Teflon felt reinforcement, the aortic arch graft is declamped, and coronary circulation is started. The first limb of the arch graft is anastomosed to the innominate artery with a 5-0 monofilament running suture(Fig 1, F), and the second limb is anastomosed to the left common carotid artery in the same fashion(Fig 1, G). After the extracorporeal circulation is terminated, the fourth limb of the arch graft, which is used for antegrade systemic perfusion, is resected(Fig 1, H).
|
Statistical method
The continuous data in this study are expressed as the mean ± SD, and categoric variables are expressed as percentages.
We analyzed 33 preoperative, perioperative, and postoperative risk factors for their possible effect on in-hospital mortality and 31 risk factors for their possible effect on postoperative neurologic outcome (Table II). First, all the independent variables were analyzed by a univariable analysis (Fisher exact test or Mann-Whitney analysis) to determine whether any single variable influenced in-hospital mortality and postoperative neurologic outcome. Variables that achieved P values of less than .2 in the univariable analysis were examined with multivariable analysis by using forward stepwise logistic regression to study their independent predictability in influencing in-hospital mortality and postoperative neurologic outcome. Survival was estimated by the Kaplan-Meier method, with variability expressed as ±95% confidence intervals (CI). All computations were performed with the SPSS 6.1 for UNIX (SPSS, Inc, Chicago, Ill) and Statview 5.0 (SAS Institute, Cary, NC) statistical software packages.
|
|
Results |
|---|
|
TopAbstractIntroductionMaterial and methodsResultsDiscussionReferences |
|---|
shows univariable analysis of in-hospital mortality and neurologic outcome. It revealed that permanent neurologic dysfunction was the only significant risk factor of in-hospital mortality. On multivariable analysis, however, no significant independent predictor of in-hospital mortality was found
In-hospital morbidity
Transient neurologic dysfunction, defined as postoperative confusion, agitation, and delirium with negative computed tomography results and complete resolution symptoms before discharge, was observed in 2 (4.0%) of the 50 patients (95% CI, 0%-9.4%). Univariable analysis revealed that CPB time was the only variable to significantly influence temporary neurologic dysfunction (Table II). On multivariable analysis, however, no significant independent predictor of temporary neurologic dysfunction was found.
Permanent neurologic dysfunction, defined as permanent neurologic deficits with localizing neurologic signs and a corresponding new defect observed on computed tomographic scanning, was noted in only 2 (4.0%) of the 50 patients (95% CI, 0%-9.4%). One patient sustained ischemic stroke because of endotracheal intubation trouble after the termination of extracorporeal circulation, and the other underwent embolic stroke. The patient with an embolic stroke recovered well and was discharged with mild hemiplegia. Cause of the stroke in this case might have been distal emboli from the femoral artery perfusion. Univariable analysis indicated that history of cerebrovascular disease was the only variable to significantly influence permanent neurologic dysfunction (Table II). Multivariable analysis, however, did not show any independent predictor of permanent neurologic dysfunction. The incidence of postoperative temporary and permanent recurrent laryngeal nerve injury was 10% (5 cases) and 6% (3 cases), respectively. There was, however, no incidence of phrenic nerve injury. Other in-hospital morbidities included hemorrhage requiring a repeat thoracotomy in 2 (4%) patients, pulmonary failure requiring support with a respirator for more than 5 days after the operation in 6 (12%) patients, renal failure (defined as a blood urea nitrogen level > 70 mg/dL or a serum creatinine level of > 3.0 mg/dL) in 3 (6%) patients, liver dysfunction (defined as a total bilirubin level >3.0 mg/dL or glutamic pyruvic transaminase level > 100 U) in 1 (2%) patient, and low cardiac output necessitating an intra-aortic balloon pump in 1 (2%) patient. One patient had a graft-esophageal fistula after the ascending aorta, total arch, and descending aortic replacement, which was successfully treated with direct repair of the esophageal perforation with wrapping by pedicled intercostal muscle and debridement and antibiotic irrigation, followed by omental wrapping of the graft. This patient is now in good condition and is free from infection 10 months after the operation.
Extracorporeal circulation data
Mean CPB time was 173.5 ± 47.1 minutes, mean aortic crossclamp time was 100.2 ± 33.9 minutes, mean systemic circulatory arrest time was 39.2 ± 14.6 minutes, and mean SCP time was 78.1 ± 16.5 minutes.Fig 2 shows patient distribution according to SCP time. Twenty-four (48%) patients had an SCP time of longer than 80 minutes. No significant correlation was found between SCP time and temporary and permanent neurologic dysfunction.
|
|
|
Discussion |
|---|
|
TopAbstractIntroductionMaterial and methodsResultsDiscussionReferences |
|---|
8-11 Atherosclerosis of the ascending aorta, carotid arterial disease, and older age have been identified as risk factors for postoperative stroke. The 1997 Society of Thoracic Surgeons National Cardiac Surgery Database reported a postoperative permanent stroke rate of 1.65%, transient stroke rate of 0.74%, delirium rate of 2.62%, and rate of continuous coma for more than 24 hours of 0.43% after CABG. 12 Stroke after CABG obviously increases the in-hospital mortality and adversely influences the length of hospital stay. Therefore, a thorough evaluation of the preoperative risk factors and appropriate intraoperative measures to reduce cerebral embolic and ischemic events are mandated. Postoperative stroke generally has a higher incidence after aortic arch operations for atherosclerotic aneurysm than after CABG. Because surgery for atherosclerotic arch aneurysm poses some additional risk of cerebral embolism and requires cerebral protection against ischemia during aortic arch exclusion, the incidence of postoperative neurologic dysfunction after this type of operation is likely to be even higher.
Some recent reports indicate that 30-day or in-hospital mortality rates after aortic arch operations for atherosclerotic aneurysm range from 6.3% to 20%, and the stroke rates for this type of operation vary from 4.0% to 11%. 1-4,13,14 Compared with these results, the 2% in-hospital mortality, 4% temporary neurologic dysfunction, and 4% permanent neurologic dysfunction that we had in our series are satisfactory outcomes.
Generally speaking, antegrade SCP as the brain protection method has been instrumental for us in improving the outcomes of aortic operations, and we have already reported its unique advantages. 5-7,15 Although postoperative stroke in aortic arch operations usually results from cerebral emboli and has nothing to do with the cerebral protection method, 1,2 our 4% temporary neurologic dysfunction is markedly lower than the 20% to 25% in other series in which profound hypothermia and circulatory arrest with or without retrograde cerebral perfusion have been used. 2,16 In addition to that, although operating for atherosclerotic arch aneurysms, we adopt the following special measures to avoid cerebral embolic events: if the aneurysm is located in the distal aorta or if there are severe atheroscletic lesions, we prefer to cannulate the ascending aorta for instituting CPB. Before cannulating the ascending aorta for CPB, epiaortic 2-dimensional ultrasonography is performed to determine an atherosclerotic plaque-free site for the cannulation. This contributes to reduced cerebral embolism from the ascending aorta. Furthermore, to reduce embolic phenomena from the distal aorta, antegrade perfusion through the fourth limb of the arch graft is initiated after the distal anastomosis is completed. The fact that we changed the arterial cannulation site during the course of this study is significant. Of the earlier 16 patients of this series who had femoral artery cannulation, 1 patient had embolic cerebral stroke. Then we switched to ascending aortic cannulation. However, the issue of the most suitable cannulation site for patients with atherosclerotic arch aneurysm continues to be investigated. The right subclavian artery or axillary artery have come up as possible options. 17 Fortunately, in the 34 patients of this series in whom we performed ascending aortic cannulation, the ascending aorta was found to be a good cannulation site by means of epiaortic ultrasonographic scanning. However, if the ascending aorta would be unsuitable, our next choice would be the right axillary artery. In fact, we have already used axillary artery cannulation at our institution and have obtained good results.
One of the key points about SCP is the arch vessel cannulation. We believe that our newly developed perfusion cannula and our recently refined cannulation technique made it easier for us to avoid the cannulation-related complications, such as cerebral embolization of dislodged atherosclerotic debris or air. Because atherosclerotic lesions are commonly located at the origins of the arch vessels, it is very important to transect them at places where they are free from such lesions to avoid dislodgment of atherosclerotic debris. Again, while cannulating, we meticulously evacuate air from the cannulas to reduce the incidence of air embolism.
Our newly developed perfusion cannula is very convenient in use because it can be bent at right angles with the help of its flexible metallic support and also allows pressure monitoring.
It has been recognized that atherosclerosis of the ascending aorta is a major cause of stroke after CABG 18-20 and also after aortic arch operations. 2 Therefore, our philosophy about the extent of aortic replacement in this type of operation is that all the potential sources of cerebral embolism must be radically removed, and that is why we also replace the ascending and the descending aorta in addition to performing the arch replacement. In these operations the site of aortic cannulation and that for infusion of cardioplegic solution are also resected because they are potential sources of cerebral emboli. 20 We have extensively used the separated graft technique by using the aortic arch branched graft for atherosclerotic arch aneurysm. This technique has several advantages when compared with en bloc repair, in which the arch vessels are anastomosed to the side hole of the arch graft in an island fashion. The use of a separated graft technique automatically excludes the atherosclerotic lesions at the origins of the arch vessels and also allows us to easily control bleeding from the arch vessel anastomosis. These can reduce the incidence of postoperative neurologic dysfunction.
The presence of carotid arterial disease is another risk factor of stroke after cardiac surgery. We routinely perform preoperative cerebral 4-vessel angiography and cerebral computed tomographic scanning to rule out carotid arterial disease, and we have not encountered this important lesion in our series.
A history of cerebrovascular disease was also a significant risk factor of stroke in our series, which is consistent with other studies on CABG 9,11 and aortic arch operations with profound hypothermia and circulatory arrest with or without retrograde cerebral perfusion. 1,2 A history of cerebrovascular disease suggests existing pathologic cerebrovascular conditions, such as impaired cerebral blood flow and autoregulation or inadequate collateral vessels, which may predispose patients to having a stroke after cardiovascular operations. Therefore, for patients with old cerebrovascular disease, further improvement in brain protection methods will be necessary.
In summary, surgery for atherosclerotic arch aneurysm carries a high risk of perioperative cerebral embolism and therefore generally has a higher postoperative stroke rate. However, our refined surgical technique for this kind of operation allowed us to significantly reduce mortality and postoperative neurologic dysfunction.
|
References |
|---|
|
TopAbstractIntroductionMaterial and methodsResultsDiscussionReferences |
|---|
Related Article
This article has been cited by other articles:
|
|
 |
|
  P. P. Urbanski, A. Lenos, P. Bougioukakis, I. Neophytou, M. Zacher, and A. Diegeler Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm? Eur J Cardiothorac Surg, January 1, 2012; 41(1): 185 - 191. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Nishi, M. Mitsuno, H. Tanaka, M. Ryomoto, S. Fukui, and Y. Miyamoto Spinal cord injury in patients undergoing total arch replacement: A cautionary note for use of the long elephant technique J. Thorac. Cardiovasc. Surg., November 1, 2011; 142(5): 1084 - 1089. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kulik, C. F. Castner, and N. T. Kouchoukos Outcomes After Total Aortic Arch Replacement With Right Axillary Artery Cannulation and a Presewn Multibranched Graft Ann. Thorac. Surg., September 1, 2011; 92(3): 889 - 897. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Zierer, F. Detho, O. Dzemali, T. Aybek, A. Moritz, and F. Bakhtiary Antegrade Cerebral Perfusion With Mild Hypothermia for Aortic Arch Replacement: Single-Center Experience in 245 Consecutive Patients Ann. Thorac. Surg., June 1, 2011; 91(6): 1868 - 1873. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Shihata, R. Mittal, A. Senthilselvan, D. Ross, A. Koshal, J. Mullen, and R. MacArthur Selective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages J. Thorac. Cardiovasc. Surg., April 1, 2011; 141(4): 948 - 952. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
O. Jonsson, A. Morell, V. Zemgulis, E. Lundstrom, T. Tovedal, G. M. Einarsson, S. Thelin, H. Ahlstrom, A. Bjornerud, and F. Lennmyr Minimal Safe Arterial Blood Flow During Selective Antegrade Cerebral Perfusion at 20{degrees} Centigrade Ann. Thorac. Surg., April 1, 2011; 91(4): 1198 - 1205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Di Bartolomeo, E. Pilato, D. Pacini, C. Savini, and M. Di Eusanio Cerebral protection during surgery of the aortic arch MMCTS, January 1, 2011; 2011(0221): mmcts.2010.004457 - mmcts.2010.004457. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Bischoff, R. M. Brenner, J. Scheumann, C. A. Bodian, R. B. Griepp, S. L. Lansman, and D. Spielvogel Long-term outcome after aortic arch replacement with a trifurcated graft J. Thorac. Cardiovasc. Surg., December 1, 2010; 140(6_suppl): S71 - S76. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Harrer, F. R. Waldenberger, G. Weiss, S. Folkmann, M. Gorlitzer, R. Moidl, and M. Grabenwoeger Aortic arch surgery using bilateral antegrade selective cerebral perfusion in combination with near-infrared spectroscopy Eur J Cardiothorac Surg, November 1, 2010; 38(5): 561 - 567. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. J. Koullias and G. H. Wheatley III State-of-the-Art of Hybrid Procedures for the Aortic Arch: A Meta-Analysis Ann. Thorac. Surg., August 1, 2010; 90(2): 689 - 697. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. P. Urbanski, A. Lenos, M. Zacher, and A. Diegeler Unilateral cerebral perfusion: right versus left, Eur J Cardiothorac Surg, June 1, 2010; 37(6): 1332 - 1336. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. K. Milewski, D. Pacini, G. W. Moser, P. Moeller, D. Cowie, W. Y. Szeto, Y. J. Woo, N. Desai, L. Di Marco, A. Pochettino, et al. Retrograde and Antegrade Cerebral Perfusion: Results in Short Elective Arch Reconstructive Times Ann. Thorac. Surg., May 1, 2010; 89(5): 1448 - 1457. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 American College of Cardiology Foundation, American Heart Association Task Force on Practice, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interve, Society of Interventional Radiology, Society of Thoracic Surgeons, Society for Vascular Medicine, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease J. Am. Coll. Cardiol., April 6, 2010; 55(14): e27 - e129. [Full Text] [PDF]
|
|
|
|
 |
|
 WRITING GROUP MEMBERS, L. F. Hiratzka, G. L. Bakris, J. A. Beckman, R. M. Bersin, V. F. Carr, D. E. Casey Jr, K. A. Eagle, L. K. Hermann, E. M. Isselbacher, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine Circulation, April 6, 2010; 121(13): e266 - e369. [Full Text] [PDF]
|
|
|
|
|
|
K. Yamana, T. Ito, A. Maekawa, T. Yoshizumi, M. Sunada, and S. Hoshino Atherosclerotic Arch Aneurysm Operations With Perfusion Toward the Aortic Valve Ann. Thorac. Surg., February 1, 2010; 89(2): 435 - 439. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Ranasinghe and R. S. Bonser The brain, the spinal cord, selective antegrade cerebral perfusion and corporeal arrest temperature -- are we reducing the margin of patient safety in aortic arch surgery? Eur J Cardiothorac Surg, December 1, 2009; 36(6): 943 - 945. [Full Text] [PDF]
|
|
|
|
 |
|
 M. Toyama, Y. Matsumura, A. Tamenishi, and H. Okamoto Safety of Mild Hypothermic Circulatory Arrest with Selective Cerebral Perfusion Asian Cardiovasc Thorac Ann, October 1, 2009; 17(5): 500 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Toda, K. Taniguchi, T. Masai, T. Takahashi, S. Kuki, Y. Sawa, and Osaka Cardiac Surgery Research (OSCAR) Group Arch Aneurysm Repair With Long Elephant Trunk: A 10-Year Experience in 111 Patients Ann. Thorac. Surg., July 1, 2009; 88(1): 16 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P Kaul, K Javangula, S Ganti, S Balaji, M Sivananthan, M Gough, and S Lindsay Continuous selective bilateral antegrade cerebral perfusion through anomalous innominate artery for repair of root, ascending aortic and arch aneurysm - challenges, vagaries and opportunities of bovine arch variant anatomy and review of literature Perfusion, March 1, 2009; 24(2): 121 - 133. [Abstract] [PDF]
|
|
|
|
 |
|
 C. A. Nienaber, I. Akin, R. Erbel, and A. Haverich CHAPTER 31 Diseases of the Aorta and Trauma to the Aorta and the Heart ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. X. Mosquera, V. Campos, M. Marini, J. V. Valle, I. Cao, D. Gulias, and A. Juffe Hybrid Procedure for Proximal Arch and Descending Aortic Aneurysms Ann. Thorac. Surg., December 1, 2008; 86(6): 1989 - 1991. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Kawasaki, K. Sugimoto, T. Taniguchi, M. Yamaguchi, M. Fujii, K. Sugimura, and Y. Okita Endovascular Treatment for Visceral Vessel Complication After Branched Graft Replacement: Initial Results Am. J. Roentgenol., October 1, 2008; 191(4): 1175 - 1181. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. M. Sundt III, T. A. Orszulak, D. J. Cook, and H. V. Schaff Improving Results of Open Arch Replacement Ann. Thorac. Surg., September 1, 2008; 86(3): 787 - 796. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ogino, H. Sasaki, K. Minatoya, H. Matsuda, H. Tanaka, H. Watanuki, M. Ando, and S. Kitamura Evolving arch surgery using integrated antegrade selective cerebral perfusion: Impact of axillary artery perfusion J. Thorac. Cardiovasc. Surg., September 1, 2008; 136(3): 641 - 649. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Morita, M. Yasaka, K. Yasumori, Y. Oishi, T. Takaseya, H. Sonoda, and T. Kawara Transcranial Doppler Study to Assess Intracranial Arterial Communication Before Aortic Arch Operation Ann. Thorac. Surg., August 1, 2008; 86(2): 448 - 451. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Numan, H. Arbatli, W. Bruszewski, and M. Cikirikcioglu Total endovascular aortic arch reconstruction via fenestration in situ with cerebral circulatory support: an acute experimental study Interact CardioVasc Thorac Surg, August 1, 2008; 7(4): 535 - 538. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui and A. H. M. Bashar The safety of moderate hypothermic circulatory arrest with selective cerebral perfusion J. Thorac. Cardiovasc. Surg., March 1, 2008; 135(3): 715 - 715. [Full Text] [PDF]
|
|
|
|
|
|
R. De Paulis, A. Salica, D. Maselli, R. Scaffa, A. Bellisario, and L. Weltert Initial Experience of an Arterial Shunt for Bilateral Antegrade Cerebral Perfusion During Hypothermic Circulatory Arrest Ann. Thorac. Surg., February 1, 2008; 85(2): 624 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Thomson, S. S. L. Tsui, J. Dunning, A. Goodwin, A. Vuylsteke, R. Latimer, J. Pepke-Zaba, and D. P. Jenkins Pulmonary endarterectomy is possible and effective without the use of complete circulatory arrest--the UK experience in over 150 patients Eur J Cardiothorac Surg, February 1, 2008; 33(2): 157 - 163. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui Editorial comment: Normothermic selective cerebral perfusion -- how safe is it? Eur J Cardiothorac Surg, August 1, 2007; 32(2): 268 - 269. [Full Text] [PDF]
|
|
|
|
|
|
K. Toda, K. Taniguchi, H. Hata, Y. Shudo, H. Matsue, S. Kuki, and Y. Sawa Single-stage repair of arch aneurysms with a long elephant trunk: Medium-term follow-up of thromboexcluded aneurysms J. Thorac. Cardiovasc. Surg., July 1, 2007; 134(1): 47 - 52. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Goto, Y. Tsutsumi, T. Kawai, and H. Ohhashi Total arch replacement of late aneurysm after bypass grafting for coarctation of the aorta Eur J Cardiothorac Surg, July 1, 2007; 32(1): 176 - 177. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Czerny, R. Gottardi, D. Zimpfer, M. Schoder, M. Grabenwoger, J. Lammer, E. Wolner, and M. Grimm Mid-term results of supraaortic transpositions for extended endovascular repair of aortic arch pathologies Eur J Cardiothorac Surg, April 1, 2007; 31(4): 623 - 627. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Suzuki, T. Kazui, S. Yamamoto, N. Washiyama, K. Ohkura, K. Ohishi, A. H. M. Bashar, K. Yamashita, H. Terada, K. Suzuki, et al. Effect of prophylactically administered edaravone during antegrade cerebral perfusion in a canine model of old cerebral infarction J. Thorac. Cardiovasc. Surg., March 1, 2007; 133(3): 710 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Antona, P. Vanelli, M. Petulla, G. Gelpi, P. Danna, M. Lemma, and L. Inglese Hybrid Technique for Total Arch Repair: Aortic Neck Reshaping for Endovascular-Graft Fixation Ann. Thorac. Surg., March 1, 2007; 83(3): 1158 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Zimpfer, M. Schoder, R. Gottardi, J. Lammer, E. Wolner, M. Grimm, and M. Czerny Treatment of Type V Endoleaks by Endovascular Redo Stent-Graft Placement Ann. Thorac. Surg., February 1, 2007; 83(2): 664 - 666. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui, K. Yamashita, N. Washiyama, H. Terada, A. H. M. Bashar, K. Suzuki, and T. Suzuki Aortic Arch Replacement Using Selective Cerebral Perfusion Ann. Thorac. Surg., February 1, 2007; 83(2): S796 - S798. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. K. Harrington, F. Fragomeni, and R. S. Bonser Cerebral Perfusion Ann. Thorac. Surg., February 1, 2007; 83(2): S799 - S804. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Sasaki, H. Ogino, H. Matsuda, K. Minatoya, M. Ando, and S. Kitamura Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience Ann. Thorac. Surg., February 1, 2007; 83(2): S805 - S810. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui Total arch replacement: technique of separate reimplantation of epi-aortic vessels MMCTS, January 1, 2007; 2007(0102): mmcts.2006.001925 - mmcts.2006.001925. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Merkkola, H. Tulla, A. Ronkainen, V. Soppi, A. Oksala, T. Koivisto, and M. Hippelainen Incomplete Circle of Willis and Right Axillary Artery Perfusion Ann. Thorac. Surg., July 1, 2006; 82(1): 74 - 79. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Matsuura, H. Ogino, H. Matsuda, K. Minatoya, H. Sasaki, T. Yagihara, and S. Kitamura Limitations of EuroSCORE for Measurement of Risk-Stratified Mortality in Aortic Arch Surgery Using Selective Cerebral Perfusion: Is Advanced Age No Longer a Risk? Ann. Thorac. Surg., June 1, 2006; 81(6): 2084 - 2087. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Czerny, R. Gottardi, D. Zimpfer, M. Schoder, M. Grabenwoger, J. Lammer, E. Wolner, and M. Grimm Transposition of the supraaortic branches for extended endovascular arch repair Eur J Cardiothorac Surg, May 1, 2006; 29(5): 709 - 713. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Della Corte, M. Scardone, G. Romano, C. Amarelli, A. Biondi, L. S. De Santo, M. De Feo, G. Nappi, and M. Cotrufo Aortic Arch Surgery: Thoracoabdominal Perfusion During Antegrade Cerebral Perfusion May Reduce Postoperative Morbidity Ann. Thorac. Surg., April 1, 2006; 81(4): 1358 - 1364. [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]
|
|
|
|
|
|
K. Matsuura, H. Ogino, H. Matsuda, K. Minatoya, H. Sasaki, A. Kada, T. Yagihara, and S. Kitamura Prediction and Incidence of Atrial Fibrillation After Aortic Arch Repair Ann. Thorac. Surg., February 1, 2006; 81(2): 514 - 518. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ogino, M. Ando, H. Sasaki, and K. Minatoya Total arch replacement using a stepwise distal anastomosis for arch aneurysms with distal extension Eur J Cardiothorac Surg, February 1, 2006; 29(2): 255 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Matsuura, H. Ogino, H. Matsuda, K. Minatoya, H. Sasaki, T. Yagihara, and S. Kitamura Surgical Outcome of Aortic Arch Repair for Patients With Takayasu Arteritis Ann. Thorac. Surg., January 1, 2006; 81(1): 178 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. P. Carrel, D.-D. Do, J. Triller, and J. Schmidli A Less Invasive Approach to Completely Repair the Aortic Arch Ann. Thorac. Surg., October 1, 2005; 80(4): 1475 - 1478. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Matsuura, H. Ogino, H. Matsuda, K. Minatoya, H. Sasaki, T. Yagihara, and S. Kitamura Multivariate analysis of predictors of late stroke after total aortic arch repair Eur J Cardiothorac Surg, September 1, 2005; 28(3): 473 - 477. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui, A. H. M. Bashar, and N. Washiyama Total aortic arch replacement and limited circulatory arrest of the brain J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 1207 - 1208. [Full Text] [PDF]
|
|
|
|
|
|
J. Akasaka, K. Tabayashi, Y. Saiki, K. Oda, K. Kumagai, and A. Iguchi Stent grafting technique using Matsui-Kitamura (MK) stent for patients with aortic arch aneurysm Eur J Cardiothorac Surg, April 1, 2005; 27(4): 649 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kuniyoshi, K. Koja, K. Miyagi, T. Uezu, S. Yamashiro, and K. Arakaki The Prevention of Nerve Injury in Aortic Arch Aneurysmal Surgery Asian Cardiovasc Thorac Ann, December 1, 2004; 12(4): 374 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Czerny, D. Zimpfer, T. Fleck, W. Hofmann, M. Schoder, M. Cejna, P. Stampfl, J. Lammer, E. Wolner, and M. Grabenwoger Initial Results After Combined Repair of Aortic Arch Aneurysms by Sequential Transposition of the Supra-Aortic Branches and Consecutive Endovascular Stent-Graft Placement Ann. Thorac. Surg., October 1, 2004; 78(4): 1256 - 1260. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Di Eusanio, A. Quarti, M. D. Pierri, and G. Di Eusanio Cannulation of the brachiocephalic trunk during surgery of the thoracic aorta: a simplified technique for antegrade cerebral perfusion Eur J Cardiothorac Surg, October 1, 2004; 26(4): 831 - 833. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
T. Kazui Editorial comment: Post-operative neuropsychological function unaffected by SjO2 monitoring in DHCA Eur J Cardiothorac Surg, March 1, 2004; 25(3): 406 - 408. [Full Text] [PDF]
|
|
|
|
|
|
J. T. Strauch, D. Spielvogel, A. Lauten, J. D. Galla, S. L. Lansman, K. McMurtry, and R. B. Griepp Technical advances in total aortic arch replacement Ann. Thorac. Surg., February 1, 2004; 77(2): 581 - 590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Takahara, K. Mogi, M. Sakurai, and H. Nishida Total aortic arch grafting via median sternotomy using integrated antegrade cerebral perfusion Ann. Thorac. Surg., November 1, 2003; 76(5): 1485 - 1489. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Czerny, T. Fleck, D. Zimpfer, M. Dworschak, W. Hofmann, D. Hutschala, D. Dunkler, M. Ehrlich, E. Wolner, and M. Grabenwoger Risk factors of mortality and permanent neurologic injury in patients undergoing ascending aortic and arch repair J. Thorac. Cardiovasc. Surg., November 1, 2003; 126(5): 1296 - 1301. [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. A. Dietl, K. Kasirajan, S. B. Pett, and J. A. Wernly Off-pump management of aortic arch aneurysm by using an endovascular thoracic stent graft J. Thorac. Cardiovasc. Surg., October 1, 2003; 126(4): 1181 - 1183. [Full Text] [PDF]
|
|
|
|
|
|
Y. Naito, M. Nakajima, H. Inoue, E. Mizutani, and K. Tsuchiya Successful treatment of a mycotic aortic arch aneurysm associated with an isolated left vertebral artery J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 883 - 885. [Full Text] [PDF]
|
|
|
|
|
|
M. Czerny, T. Fleck, D. Zimpfer, J. Kilo, D. Sandner, M. Cejna, J. Lammer, E. Wolner, and M. Grabenwoger Combined repair of an aortic arch aneurysm by sequential transposition of the supra-aortic branches and endovascular stent-graft placement J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 916 - 918. [Full Text] [PDF]
|
|
|
|
|
|
T. Ohata, T. Sakakibara, H. Takano, and T. Ishizaka Total arch replacement for thoracic aortic aneurysm via median sternotomy with or without left anterolateral thoracotomy Ann. Thorac. Surg., June 1, 2003; 75(6): 1792 - 1796. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Spielvogel, M. N. Mathur, S. L. Lansman, and R. B. Griepp Aortic arch reconstruction using a trifurcated graft Ann. Thorac. Surg., March 1, 2003; 75(3): 1034 - 1036. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Spielvogel, M. N. Mathur, and R. B. Griepp Aneurysms of the Aortic Arch Card. Surg. Adult, January 1, 2003; 2(2003): 1149 - 1168. [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 - S1809. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Nishimura, S. Ohtake, Y. Sawa, T. Takahashi, G. Matsumiya, K. Kagisaki, Y. Miyamoto, and H. Matsuda Arch-first technique for aortic arch aneurysm repair through median sternotomy Ann. Thorac. Surg., October 1, 2002; 74(4): 1264 - 1266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kuki, K. Taniguchi, T. Masai, T. Yokota, K. Yoshida, K. Yamamoto, and H. Matsuda An Alternative Approach Using Long Elephant Trunk for Extensive Aortic Aneurysm: Elephant Trunk Anastomosis at the Base of the Innominate Artery Circulation, September 24, 2002; 106(12_suppl_1): I-253 - I-258. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Moon and T. M. Sundt III Influence of retrograde cerebral perfusion during aortic arch procedures Ann. Thorac. Surg., August 1, 2002; 74(2): 426 - 431. [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]
|
|
|
|
|
|
A. Mazzola, R. Gregorini, C. Villani, and M. Di Eusanio Antegrade cerebral perfusion by axillary artery and left carotid artery inflow at moderate hypothermia Eur J Cardiothorac Surg, May 1, 2002; 21(5): 930 - 931. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Kazui, A. H. M. Bashar, and N. Washiyama Impact of the duration of adjunctive hypothermic circulatory arrest on neurologic outcome with antegrade cerebral perfusion J. Thorac. Cardiovasc. Surg., March 1, 2002; 123(3): 581 - 582. [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]
|
|
|
|
|
|
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]
|
|
|
|
|
|
K. Yamashita, T. Kazui, H. Terada, N. Washiyama, K. Suzuki, and A. H. M. Bashar Cerebral oxygenation monitoring for total arch replacement using selective cerebral perfusion Ann. Thorac. Surg., August 1, 2001; 72(2): 503 - 508. [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 |
