CEREBRAL COMPLICATIONS OF PERFUSION
1
NLM CIT. ID: 97436859
TITLE: Psychiatric complications of cardiac surgery postoperative
delirium syndrome.
AUTHOR: Gokgoz L; Ersoz A; Inanir S; Halit V; Soncul H
Babacan A; Boratav C; Unlu M; Sinci V; Gunaydin S
ADDRESS:
Department of Cardiovascular Surgery, Gazi University, School of
Medicine, Ankara, Turkey.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
Psychiatric disturbances due to cardiopulmonary bypass,
especially postoperative delirium syndrome, are among the
immediate complications of open-heart surgery. In a series of 32
male and 18 female patients the prevalence of such disorders was
investigated and search was made for possible risk factors for
their occurrence. Psychiatric, neurologic and
electroencephalographic evaluation was made pre- and
postoperatively, in addition to haemodynamic, echocardiographic,
angiographic and regional cerebral blood flow studies. Nine of
the 50 patients had significantly reduced perfusion of certain
cerebral lobes in single photon emission computed tomography, and
in six of them the psychiatric tests indicated postoperative
delirium; three of these six also had moderate
electroencephalographic changes. The cerebral hypoperfusion
persisted on day 15 in four patients, while psychiatric tests
were negative. The study showed possible risk factors to be
patient age, long aortic cross-clamp time, high-dose inotropic
support and excessive transfusion of blood or blood products.
SOURCE: Scand Cardiovasc J 1997;31(4):217-22
2
NLM CIT. ID: 97403741
TITLE: [The etiology of neurological complications after cardiopulmonary
bypass surgery]
AUTHOR: Carrascal Y; Rufilanchas JJ; Rodriguez-Hernandez JE
Lopez-Gude MJ; Maroto LC; Guerrero-Peral AL
ADDRESS:
Servicio de Cirugia Cardiaca, Hospital Doce de Octubre, Madrid,
Espana.
PUBLICATION TYPES:
JOURNAL ARTICLE
REVIEW
REVIEW, TUTORIAL
LANGUAGE: Spa
ABSTRACT:
INTRODUCTION: Cardiopulmonary bypass (CEC) in the surgical
treatment of cardiac diseases may cause the appearance of
neurological damage of an intensity which varies between minor
neuropsychological disorders and global cerebral anoxia. There
are two mechanisms for the production of these lesions: ischaemic
and embolic. The mortality associated with this type of
complication is low, but morbidity may be considerable. The
neurological disorders derived from CEC may be classified
according to the aetiology and clinical findings. In the first
group are included: severe cerebral anoxia, embolic
cerebro-vascular accidents, microvascular embolias, lesions of
spinal vascularization and lesions of the peripheral nerves. In
the second group are: encephalic focal lesions, convulsive
crises, lesions of the extra-pyramidal system, alterations in the
level of consciousness and neuropsychological disorders. METHODS:
Quantification of neuronal damage has been attempted by:
monitoring cerebral blood flow and neurone metabolism, EEG and
study of intra-operative evoked potentials, echography of the
carotid, cardiac and ascending aorta, transcranial doppler,
fluorescein-angiography and the study of biochemical markers of
neuronal and glial damage. Different studies have identified a
series of factors which potentiate the risk of neurological
lesions following CEC. These are: age, severe carotid disease,
aortic atherosclerosis and previous cerebro-vascular haemorrhage,
amongst others. An attempt is made to reduce the incidence of
neurological complications by: pre-operative evaluation of
carotid bruits, hypothermia, careful surgical technique and the
use of drugs with a neuroglial protector effect. None of these
methods gives sufficiently effective protection to the central
nervous system subjected to the changes involved in the use of
CEC. CONCLUSION: There are still many unknown aspects of neurone
pathology in these circumstances, leaving a door open to
investigation.
SOURCE: Rev Neurol 1997 Aug;25(144):1278-84
3
NLM CIT. ID: 97452663
TITLE: Open distal anastomosis in retrograde cerebral perfusion for
repair of ascending aortic dissection.
AUTHOR: Yamashita C; Yamashita T; Wakiyama H; Nakagiri K
Azami T; Yoshimura N; Yoshida M; Ataka K; Okada M
ADDRESS:
Department of Surgery, Kobe University School of Medicine, Japan.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
BACKGROUND: In patients with aortic dissection, a patent distal
false lumen at long-term follow-up leads to complications. We
investigated the feasibility of performing an open distal
anastomosis using retrograde cerebral perfusion. METHODS: Over a
10-year period, 41 patients with acute type A aortic dissection
underwent 43 surgical repairs. In 1991, an open distal
anastomosis using retrograde cerebral perfusion (group 2) was
introduced to replace the standard aortic cross-clamp method
(group 1). The mean retrograde cerebral perfusion time was 47.3
minutes (range, 22 to 67 minutes), and there were no neurologic
sequelae in surviving patients. RESULTS: The operative mortality
rate was 18.5% in group 1 and 18.7% in group 2. At long-term
follow-up, dilatation of the false lumen (more than 50 mm in
diameter) occurred in 9 of 18 patients (50%) in group 1, and 2
patients died of aortic rupture. There were no deaths in group 2,
and dilatation of the distal false lumen occurred in only 15.4%
of patients (p < 0.05). CONCLUSIONS: The use of retrograde
cerebral perfusion in patients with acute aortic dissection
provides adequate time to perform a safe, open, distal
anastomosis, and could decrease significantly the rate of
enlarged, patent, false lumina.
SOURCE: Ann Thorac Surg 1997 Sep;64(3):665-9
4
NLM CIT. ID: 97417691
TITLE: Use of hypothermic circulatory arrest for cerebral protection
during aortic surgery.
AUTHOR: Griepp RB; Griepp EB; Chang N; Juvonen T; Nguyen KH
McCullough JN; Ergin MA
ADDRESS:
Department of Cardiothoracic Surgery, Mount Sinai Medical Center,
New York, New York 10029, USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
REVIEW
REVIEW, TUTORIAL
LANGUAGE: Eng
ABSTRACT:
Optimal use of hypothermic circulatory arrest during aortic
surgery requires understanding of its physiology. Research in
laboratory animals and clinical observations have now documented
that considerable residual cerebral metabolism remains with
cooling to levels of 15-18 degrees C, especially if cooling
intervals are short, reflected by persistent jugular venous
desaturation. Cooling should be continued to below 15 degrees C
if the duration of HCA is expected to exceed 20 minutes, and
continued until jugular venous saturations exceed 95%. There is
considerable laboratory evidence that even short durations of HCA
are followed by a prolonged interval of increased cerebral
vascular resistance during which cerebral metabolism is
maintained at normal levels by markedly increased oxygen
extraction. Clinical observations have now confirmed that
considerable jugular venous desaturation is present in patients
following HCA: it is more pronounced with prolonged HCA, and is
still present as late as six hours after the start of rewarming.
This reinforces the concept of a prolonged postoperative
vulnerable interval following HCA, during which any compromise in
oxygen delivery has the potential for producing cerebral injury.
Several adjunctive measures have been shown to improve outcome
following HCA. The simplest and most important is topical
hypothermia: packing the head in ice during the interval of HCA.
Retrograde cerebral perfusion (RCP) has also been shown to
improve EEG recovery as well as histological and behavioral
outcome in laboratory animals following prolonged HCA, but some
of its effect may be secondary to its efficacy in keeping the
brain cold, since RCP provides very low rates of flow and
supports metabolism at a much lower level than antegrade
perfusion at the same temperature. But despite the clear
superiority of antegrade perfusion, and the documentation of some
benefits of RCP in laboratory measures of cerebral protection,
clinical results using RCP and ACP have not yet demonstrated the
superiority of these methods over use of HCA alone, perhaps
because these modalities are usually employed in patients with
unusually high risk of neurological injury: those with dissection
or with clot or atheroma in the aorta. Nevertheless, recent years
have seen considerable reduction in mortality following aortic
surgery, especially in older patients, and a trend toward a lower
incidence of permanent neurologic dysfunction. The presence of
preoperative rupture or hemodynamic compromise, and of clot or
atheroma in the aorta, remain the most significant risk factors
both for death and occurrence of stroke.
SOURCE: J Card Surg 1997 Mar-Apr;12(2 Suppl):312-21
5
NLM CIT. ID: 97417674
TITLE: Diagnosis and management of blunt great vessel trauma.
AUTHOR: von Segesser LK; Turina M; Vogt P; Fischer A
ADDRESS:
Clinics for Cardiovascular Surgery, University Hospitals,
Lausanne, Switzerland.
PUBLICATION TYPES:
JOURNAL ARTICLE
REVIEW
REVIEW, TUTORIAL
LANGUAGE: Eng
ABSTRACT:
Traditionally, thoracic aortic rupture, suspected after blunt
thoracic trauma, is characterized by a chest radiograph showing a
widened mediastinum. The diagnostic machinery consecutively
activated still depends heavily on the pressure as additional
traumatic lesions. A patient with additional cranio-cerebral
trauma would typically undergo contrast-enhanced computed
tomography or magnetic resonance imaging of head, chest, and
other regions. In a number of patients these analyses would
confirm the presence of blood in the mediastinum without formal
proof of an aortic disruption. This is because mediastinal
hematomas may be caused not only by an aortic rupture, but also
by numerous other blood sources including fractures of the spine
and other macro- and microvascular lesions providing similar
images. Therefore, aortic angiography became our preferred
diagnostic tool to identify or rule out acute traumatic lesions
of not only the aorta but with great vessels. However recently, a
number of traumatic aortic transsections have been identified by
transoesophageal echocardiography (TEE). TEE has the additional
advantage of being a bed-side procedure providing additional
information about cardiac function. The latter analysis allows
for identification and quantification of cardiac contusions,
post-traumatic myocardial infarctions, and valvar lesions which
are of prime importance to develop an adequate surgical strategy
and to assess the risk of the numerous emergency procedures
required in patients with polytrauma. The standard approach for
repair of isthmic aortic rupture is through a lateral
thoracotomy. Distal and proximal control of the aorta can be
achieved in a substantial number of cases before complete aortic
rupture occurs and a higher proportion of direct suture repair
can be achieved under such circumstances. Most proximal
descending aortic procedures are performed without
cardiopulmonary bypass (clamp and go) but paraplegia may occur
before, during, or after the procedure. Ascending aortic lesions
and disruption of the aortic arch, the supra-aortic vessels, the
main pulmonary arteries, the great veins as well as cardiac
lesions are best approached through a sternotomy, which may have
to be extended. Cardiopulmonary bypass allowing for deep
hypothermia and circulatory arrest is often required and carries
its own complications. It is not clear whether the increasing
proportion of ascending aortic and cardiac lesions which are
observed nowadays are due to a change in trauma mechanics (i.e.,
speed limits, seat belts, air-bags), an improvement of the
diagnostic tools or both.
SOURCE: J Card Surg 1997 Mar-Apr;12(2 Suppl):181-6; discussion 186-92
6
NLM CIT. ID: 97370342
TITLE: Neurone-specific enolase and Sangtec 100 assays during cardiac
surgery: Part III--Dose haemolysis affect their accuracy?
AUTHOR: Gao F; Sharp S; Sapsed-Byrne S; Harris DN
ADDRESS:
Department of Anaesthesia, Royal Postgraduate Medical School,
London, UK.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
EC 4.2.1.11 (Phosphopyruvate Hydratase)
0 (Nerve Tissue Protein S 100)
0 (Nerve Tissue Proteins)
0 (Reagent Kits, Diagnostic)
ABSTRACT:
Neurone-specific enolase (NSE) and Sangtec 100 (S-100) are useful
for detecting cerebral damage during cardiopulmonary bypass
(CPB). However, red cells contain NSE, and the haemolysis
frequently caused by CPB could produce a false rise in NSE; S-100
is not found in red cells and should not be affected. We,
therefore, compared the effects of haemolysis on NSE and S-100 to
see if correction was necessary and possible. From seven
patients, serial dilutions of haemolysed red cells were added to
plasma (1/64-1/2048), measured for absorption at 540 nm and
assayed for NSE and S-100. S-100 concentrations showed no change
with haemolysis. Measured NSE increased significantly with
haemolysis > 1/512 (an increase of 6.6 micrograms/ml): a
correction formula is presented. In 39/48 patients after CPB,
mean haemolysis was < 1/256 and would not need any correction.
NSE and S-100 assay can, therefore, be used throughout CPB, which
allows both glial and neuronal damage to be studied.
SOURCE: Perfusion 1997 May;12(3):171-7
7
NLM CIT. ID: 97370341
TITLE: Neurone-specific enolase and Sangtec 100 assays during cardiac
surgery: Part II--Must samples be spun within 30 min?
AUTHOR: Sapsed-Byrne S; Harris DN; Gao F
ADDRESS:
Department of Anaesthesia, Royal Postgraduate Medical School,
London, UK.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
EC 4.2.1.11 (Phosphopyruvate Hydratase)
0 (Nerve Tissue Protein S 100)
0 (Nerve Tissue Proteins)
0 (Reagent Kits, Diagnostic)
ABSTRACT:
Sangtec 100 (S-100) (Sangtec Medical, Sweden) and
neurone-specific enolase (NSE) assays are showing promise in the
assessment of cerebral damage following cardiopulmonary bypass
(CBP). The manufacturer's instructions state, however, that
samples must be spun and frozen within 30 min, which is
inconvenient for serial studies. We, therefore, investigated
whether strong blood samples at room temperature (RT) or 4
degrees C for up to 48 h affected the measured levels. Blood
samples were taken before and after CBP in six patients and
stored for 15 min, 4, 8, 24 or 48 h at RT or 4 degrees C. S-100
and NSE levels did not alter in either 'before surgery' or CPB
samples when stored for up to 48 h at 4 degrees C. There was a
small, nonsignificant rise when stored at RT. Samples may,
therefore, be collected throughout long operations or stored
overnight without affecting NSE or S-100 plasma levels.
SOURCE: Perfusion 1997 May;12(3):167-9
8
NLM CIT. ID: 97370340
TITLE: Neurone-specific enolase and Sangtec 100 assays during cardiac
surgery: Part I--The effects of heparin, protamine and propofol.
AUTHOR: Gao F; Sharp S; Sapsed-Byrne S; Harris DN
ADDRESS:
Department of Anaesthesia, Royal Postgraduate Medical School,
London, UK.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
EC 4.2.1.11 (Phosphopyruvate Hydratase)
0 (Anesthetics, Intravenous)
0 (Anticoagulants)
0 (Nerve Tissue Protein S 100)
0 (Nerve Tissue Proteins)
0 (Protamines)
0 (Reagent Kits, Diagnostic)
2078-54-8 (Propofol)
9005-49-6 (Heparin)
ABSTRACT:
Neurone-specific enolase (NSE) and Sangtec 100 (S-100) (Sangtec
Medical, Sweden) assays are designed for clotted samples, but
when studying cerebral damage following cardiac surgery,
perioperative samples will contain heparin and/or protamine. The
lipid emulsion propofol is also frequently used during cardiac
surgery and could affect the assays. We, therefore, studied the
effects of heparin, protamine and propofol on the accuracy of NSE
and S-100 assays in five healthy patients. Blood samples were
taken and divided into four groups: normal saline was added to
group A; heparin to group B; heparin followed by protamine to
group C; and propofol to group D. NSE and S-100 concentrations
were measured for all samples. Neither heparin, protamine nor
propofol affected the accuracy of S-100 and NSE assays;
therefore, samples can be taken throughout operations involving
cardiopulmonary bypass without influencing the results.
SOURCE: Perfusion 1997 May;12(3):163-5
9
NLM CIT. ID: 97408069
TITLE: Evaluation of brain oxygenation during selective cerebral
perfusion by near-infrared spectroscopy.
AUTHOR: Katoh T; Maekawa T; Nakashima K; Zempo N; Fujimura Y
Hamano K; Gohra H; Esato K
ADDRESS:
First Department of Surgery and Critical Care Medical Center,
Yamaguchi University School of Medicine, Ube, Japan.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
0 (Hemoglobins)
0 (Oxyhemoglobins)
9008-02-0 (deoxyhemoglobin)
ABSTRACT:
BACKGROUND: Although selective cerebral perfusion (SCP) has been
used for cerebral protection in aortic arch operations, the
appropriate perfusion conditions of SCP are unclear. METHODS: We
used near-infrared spectroscopy, which evaluates brain ischemia
noninvasively and continuously, to determine whether perfusion
with SCP (core temperature, 20 degrees C; flow rate, 10
mL.kg-1.min-1) was acceptable in terms of oxyhemoglobin and
deoxyhemoglobin in patients having SCP for aortic arch operations
(SCP group, n = 6) versus patients having cardiopulmonary bypass
(CPB) for coronary artery bypass grafting (CPB group, n = 6).
RESULTS: There were no significant differences in age (65 +/- 10
versus 63 +/- 12 years), CPB time (199 +/- 67 versus 199 +/- 52
minutes), changes in hematocrit (-12.9% +/- 3.7% versus -12.5%
+/- 6.0%), lowest blood pressure (43 +/- 7 versus 45 +/- 10 mm
Hg), or highest central venous pressure (8 +/- 2 versus 9 +/- 4
mm Hg) between the SCP and CPB groups. In the SCP group, the
maximum decrease in oxyhemoglobin level and the maximum increase
in deoxyhemoglobin level were -5.0 to -11.4 mumol/L and -0.1 to
3.9 mumol/L, respectively; in the CPB group, the respective
changes were -3.2 to -14.2 mumol/L and -0.4 to 3.6 mumol/L.
Changes of oxyhemoglobin and deoxyhemoglobin levels in the SCP
group were almost within the range of those in the CPB group.
There were no brain complications in either group. CONCLUSIONS:
As described here, SCP is acceptable and safe for brain
protection in aortic arch procedures.
SOURCE: Ann Thorac Surg 1997 Aug;64(2):432-6
10
NLM CIT. ID: 97326916
TITLE: Passive retrograde cerebral perfusion during routine cardiac
valve surgery reverses middle cerebral artery blood flow and
reduces the risk of stroke.
AUTHOR: Quigley RL; Reitknecht FL; Sampson LN; Fuller BC
ADDRESS:
Department of Surgery, Guthrie Clinic, Sayre, Pennsylvania 18840,
USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
BACKGROUND AND AIMS OF THE STUDY: Cerebral complications
constitute a major source of morbidity and disability after
cardiac valve surgery. These may be the result of
macroembolization (air/debris) or inadequate perfusion pressure.
In an attempt to reduce the incidence of cerebral vascular
accident (CVA)/transient ischemic attack (TIA), we have routinely
performed three minutes of passive retrograde cerebral perfusion
(PRCP) on all valve cases. Here, we retrospectively determined
our perioperative (0-30 day) incidence of CVA/TIA. METHODS: In
all cases, the extracorporeal circuit consisted of an ascending
aortic cannula and either one two-stage or two single-stage
venous cannulae. Three minutes of PRCP was instituted in all
cases upon discontinuation of anterograde cardiopulmonary bypass
(CPB) via a shunt distal to the heart/lung machine between the
arterial and venous cannulae. Mean systemic blood pressure was
maintained at 60 mmHg with Neo-Synephrine. Central venous
pressure never exceeded 25 mmHg. In 10 cases, transcranial
Doppler ultrasonography (TCD) was used to assess middle cerebral
artery (MCA) blood flow. In total, 209 consecutive valve
procedures with PRCP (group A) were compared with 164 consecutive
valve procedures with no PRCP (group B). All data were compared
using Fisher's exact probability test. The incidence of CVA/TIA
was also compared with published retrospective and prospective
data. RESULTS: TCD demonstrated blood flow reversal in the MCA
after a minimum of 30 s. The incidence of CVA/TIA was 0% (0/209)
in group A, and 2.4% (4/165) in group B (p = 0.0386). The
incidence of CVA/TIA in published retrospective data is 0.7-3.8%
and 4.8-5.2% in prospective data. CONCLUSIONS: We have
demonstrated in 209 consecutive valve cases that, upon
discontinuation of CPB, routine three-minute PRCP not only
reversed MCA blood flow, but also reduced the incidence of
neurologic events.
SOURCE: J Heart Valve Dis 1997 May;6(3):288-91
11
NLM CIT. ID: 97339716
TITLE: Clinical effects of the heparin coated surface in cardiopulmonary
bypass.
AUTHOR: Svenmarker S; Aberg T; Appelblad M; Lindholm R
Haggmark S; Jansson E; Karlsson T; Sandstrom E
ADDRESS:
Department of Cardio-thoracic Surgery, University Hospital of
Ume~a, Sweden.
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL
LANGUAGE: Eng
REGISTRY NUMBERS:
0 (Anticoagulants)
0 (Nerve Tissue Protein S 100)
9005-49-6 (Heparin)
ABSTRACT:
OBJECTIVE: In a randomised study of 120 patients, undergoing
primary operation for coronary heart decease, two groups were
investigated as regards to the effects of heparin coated
cardiopulmonary bypass on brain function parameters and general
clinical outcome. The study group (n = 56) was perfused using an
extra-corporeal circuit treated with covalent bonded heparin; the
control group (n = 59) used an identical set-up without heparin
treatment. Systemic heparin doses were calculated to achieve ACT
levels of 250 and 500 s, respectively. Postoperative course was
evaluated by examining a set of clinically relevant parameters
including a detailed registry of postoperative deviations. Brain
function was assessed by the biochemical marker S-100 and tests
of memory performance. RESULTS: There were several signs of
reduced operative trauma in the study group. Hospital stay was
reduced by nearly 1 day (P < 0.05). Time on postoperative
ventilatory support was approximately 4 h shorter (P = 0.009).
Chest drain blood loss was decreased both at 8 (P = 0.01) and 24
h (P = 0.007) postoperatively. Body temperature was lower after
surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01).
Perioperative creatinine elevation was significantly reduced (P =
0.03). Neurological deviations were fewer (P = 0.01). Brain
function assessment revealed reduced plasma levels of S-100 both
at termination of cardiopulmonary bypass (P = 0.008) and 7 h
later (P = 0.04). However, no remediation of memory impairment
could be demonstrated. CONCLUSIONS: Cardiopulmonary bypass with
covalent bonded heparin attached to the extra-corporeal circuit
in combination with a reduced systemic heparin dose seems to
reduce safely and effectively the operative stress to the
patient. There were also signs of improved cerebral protection.
SOURCE: Eur J Cardiothorac Surg 1997 May;11(5):957-64
12
NLM CIT. ID: 97339715
TITLE: Long-term results of patch repair for saccular aneurysms of the
transverse aortic arch.
AUTHOR: Okita Y; Nakajima N; Kawashima Y; Matsukawa R
Yamaki F; Morota T; Ando M; Takamoto S
ADDRESS:
Department of Cardiovascular Surgery, National Cardiovascular
Center, Suita, Osaka, Japan. yokita@hsp.ncvc.go.jp
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
0 (Polyethylene Terephthalates)
9002-84-0 (Polytetrafluoroethylene)
ABSTRACT:
OBJECTIVE: Long-term results of patch repair in patients with a
saccular aneurysm of the aortic arch were investigated. PATIENTS:
From December 1984, 43 patients with a saccular aneurysm of the
arch underwent patch repair. Indications for patch repair were
determined as orifice diameter of aneurysm being less than 1/3 of
the total circumference of the aorta. METHOD: Midsternotomy was
used in 38 patients, and left thoracotomy in five. Selective
cerebral perfusion was used in 28 patients, deep hypothermic
circulatory arrest with retrograde cerebral perfusion in eight
during the last 3 years, and partial cardiopulmonary bypass in
seven. RESULTS: There were five (11.6%) early deaths, and causes
were respiratory failure in two patients, low cardiac output in
two, and gastrointestinal bleeding in one. Stroke was found in
three patients (6.9%). During follow-up, seven patients died, two
due to rupture of a residual or pseudoaneurysm, one due to
reoperation of pseudoaneurysm, one due to stroke, two due to
respiratory failure, and one due to unknown cause. Postoperative
survival, including early death, was 69.3% at 5 years and 43.3%
at 9 years. Aortic reoperation was done in three patients with a
pseudoaneurysm formation and two survived. Freedom from
reoperation was 91.7% at 5 years and 38.2% at 9 years. Event free
ratio was 79.3 +/- 9.8% at 5 years and 37.6 +/- 18.6% at 9 years.
CONCLUSION: Because of a high incidence of pseudoaneurysm or
residual aneurysms after patch repair for a saccular aneurysm of
the aortic arch, strict criteria for the patch repair should be
applied or graft replacement of the aorta is recommended.
SOURCE: Eur J Cardiothorac Surg 1997 May;11(5):953-6
13
NLM CIT. ID: 97349154
TITLE: Risk factors and solutions for the development of neurobehavioral
changes after coronary artery bypass grafting.
AUTHOR: Hammon JW Jr; Troost BT; Coker LH; Hilbawi R
Rogers AT; Brooker RF; Oaks TE; Hudspeth AS; Cordell AR; Kon ND
Stump DA
ADDRESS:
Department of Cardiothoracic Surgery, The Bowman Gray School of
Medicine of Wake Forest University, Winston-Salem, North Carolina
27157, USA.
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
BACKGROUND: As operative mortality for coronary artery bypass
grafting has decreased, greater attention has focused on
neurobehavioral complications of coronary artery bypass grafting
and cardiopulmonary bypass. METHODS: To assess risk factors and
to evaluate changes in surgical technique, between 1991 and 1994
we evaluated 395 patients undergoing coronary artery bypass
grafting with an 11-part neurobehavioral battery administered
preoperatively and at 1 and 6 weeks postoperatively. Patients
were instrumented with 5-MHz focused continuous-wave carotid
Doppler transducers intraoperatively to estimate cerebral
microembolism as an instantaneous perturbation of the velocity
signal. Microembolism data were quantitated and compared with
surgical technical maneuvers during operation and with
neurobehavioral deficit (> or = 20% decline from preoperative
performance on two or more neurobehavioral tests)
postoperatively. These data and patient demographics were
statistically analyzed (chi2, t test) and the results at 2 years
(1991 and 1992; group A) were used to influence surgical
technique in 1993 and 1994 (group B). RESULTS: Significantly
associated with new neurobehavioral deficits were increasing
patient age (p < 0.05), more than 100 emboli per case (p < 0.04),
and palpable aortic plaque (p < 0.02). Group B patients had a
significant decline in the neurobehavioral event rate (group A,
69%, 140/203; versus group B, 60%, 115/192; p < 0.05) of
postoperative neurobehavioral deficits at 1 week and at 1 month
(group A, 29%, 52/180; versus group B, 18%, 35/198; p < 0.01).
The stroke rate was less than 2% in both groups (p = not
significant). Modifications of surgical technique used in group B
patients included increased use of single cross-clamp technique,
increased venting of the left ventricle, and application of
transesophageal and epiaortic ultrasound scanning to locate and
avoid trauma to aortic atherosclerotic plaques. CONCLUSIONS:
Neurobehavioral changes after coronary artery bypass grafting are
common and associated with cerebral microembolization. Surgical
technical maneuvers designed to reduce emboli production may
improve neurobehavioral outcome.
SOURCE: Ann Thorac Surg 1997 Jun;63(6):1613-8
14
NLM CIT. ID: 97304079
TITLE: Intermittent antegrade/selective cerebral perfusion during
circulatory arrest for repair of the aortic arch.
AUTHOR: Maas C; Haalebos MM; Leicher FG; van der Starre PJ
Ennema J; de Vries I; Eilander S; Boogaart A; Segers P; Kok R
ADDRESS:
Department of Extracorporeal Circulation, Weezenlanden Hospital,
Zwolle, The Netherlands.
PUBLICATION TYPES:
JOURNAL ARTICLE
REVIEW
REVIEW, TUTORIAL
LANGUAGE: Eng
ABSTRACT:
If the aortic arch requires repair or replacement due to an
aneurysm or dissection, conventional cardiopulmonary bypass (CPB)
is not possible during the period in which the aortic arch is
excluded from the circulation. This creates a situation in which
there is no cerebral circulation. The brain needs adequate
protection from this ischaemic insult. Hypothermic circulatory
arrest (HCA), antegrade/selective cerebral perfusion (ASCP) and
retrograde cerebral perfusion (RCP) are reported to exhibit their
cerebral protective capabilities during procedures involving the
aortic arch. HCA can provide adequate protection in procedures of
short duration and avoids the complications associated with
cerebral perfusion techniques. The main disadvantage of HCA is
that the 'safe' duration of circulatory arrest is not clearly
defined. Topical cooling of the head may enhance cerebral
hypothermia and provide additional protection. If longer periods
of circulatory arrest are anticipated or occur unexpectedly, we
suggest that ASCP can offer improved cerebral protection by
providing adequate brain perfusion and improved cerebral cooling.
By using a coronary sinus perfusion catheter as a carotid artery
cannula, it is not necessary to snare or clamp the carotid
arteries. This technique minimizes the chance of damaging the
carotid arteries. In this report, we describe our set-up and ASCP
perfusion protocol for the surgical repair of an aortic arch
aneurysm.
SOURCE: Perfusion 1997 Mar;12(2):127-32
15
NLM CIT. ID: 97295389
TITLE: Serum S-100 protein concentration after cardiac surgery: a
randomized trial of arterial line filtration.
AUTHOR: Taggart DP; Westaby S; Johnssson P; Pillai R; Kay JD
Standing SJ; Meston N; Bhattacharya K
ADDRESS:
Oxford Heart Centre, John Radcliffe Hospital, UK.
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL
LANGUAGE: Eng
REGISTRY NUMBERS:
0 (Nerve Tissue Protein S 100)
ABSTRACT:
INTRODUCTION: Embolization of gaseous and particulate matter is
incriminated in the neuropsychological morbidity of CPB and can
be reduced by membrane oxygenators and arterial line filtration.
It is not known if the use of arterial line filtration in
conjunction with membrane oxygenators might have an additive
effect in reducing cerebral injury. METHODS: Forty patients
undergoing elective coronary artery surgery were prospectively
randomized to a 43 microns heparin coated arterial line filter
(Cobe Sentry) or to no filtration (control group). All operations
were performed by one surgeon (DPT) using intermittent ischaemia
with nonpulsatile CPB, a COBE CML membrane oxygenator and
alpha-stat paCO2 management. Flow rates were maintained between
2.0 and 2.4 l-1 m2 per min with a perfusion pressure of 50-80
mmHg and a systemic temperature of 34 degrees C. Cerebral injury
was defined by careful neurological examination and serial
measurement of the serum concentration of S-100 protein (a highly
specific astroglial cell derivative, elevated serum levels of
which correlate with proven cerebral injury). RESULTS: There was
no difference [mean (S.D.)] in the control and filter groups with
respect to age [61(9) vs. 62(9) years], ejection fraction, number
of grafts [2.8(0.6) vs. 2.6(0.7)] or CPB times [55(19) vs. 57(18)
min]. Preoperatively, no patient had detectable S-100. In the
postoperative period 23 of 40 patients (58%) showed elevated
S-100 levels. At 1, 5 and 24 h the respective number of patients
in the control and filter groups with elevated S-100 was (14 vs.
9), (4 vs. 0), (4 vs. 0)) (P < 0.05). No patient had overt
cerebral injury. CONCLUSIONS: This study suggests that (i)
subclinical cerebral injury is common (58% of patients in this
study) even after apparently uncomplicated surgery with short CPB
times; (ii) serum S-100 protein is a valuable marker for
investigating potentially cerebral protective innovations during
CPB; and (iii) arterial line filtration significantly reduces but
does not eliminate cerebral injury.
SOURCE: Eur J Cardiothorac Surg 1997 Apr;11(4):645-9
16
NLM CIT. ID: 97295388
TITLE: A predictive parameter in patients with brain related
complications after cardiac surgery?
AUTHOR: Isgro F; Saggau W; Pohl P; Schmidt C
ADDRESS:
Herzzentrum Ludwigshafen, Clinic for Cardiac surgery, Germany.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
EC 4.2.1.11 (Phosphopyruvate Hydratase)
0 (Biological Markers)
ABSTRACT:
OBJECTIVE: The prognostic estimation of cerebral complications
after cardiac surgery is a major problem in the early
postoperative period. Neuron specific enolase (NSE) is an enzyme
involved in glycolysis, which is localized in neurons and axonal
processes. It escapes into the blood and cerebrospinal fluid at
the time of neural injury. Therefore we focused the study on the
question of how far serum levels of neuron specific enolase can
predict the neurological and neuropsychological outcome after
cardiac surgery. METHODS: We determined, with a prospective study
design of NSE serum levels in 200 patients undergoing cardiac
surgery preoperatively, right after the operation and 48 h later.
The NSE was measured with a solid phase enzyme immuno assay which
utilized a highly specific monoclonal antibody to NSE. We
evaluated the neurological and neuropsychological status before
and 72 h after surgical intervention. As a control group we
recruited 50 patients undergoing general surgical treatment.
RESULTS: The preoperative serum levels of NSE are constantly low
in all patients with a mean value of 11.1 ng/ml (8.3-13.6) and a
mean +/- S.D. of 3.12 in the main group and a mean value of 9.6
ng/ml (7.8-10.3) and a mean +/- S.D. of 1.84 in the control
group. The early postoperative measurements indicated a
significant increase to a mean value of 19.7 ng/ml (8.7-70.9)
with a mean +/- S.D. of 2.89 in the main group. In contrast there
is no increase of NSE serum levels after general surgery. The 48
h postoperative mean levels declined to 14.2 ng/ml (9.9-26.2),
S.D. of 3.23. In 17 out of the 200 patients a neurological
complication occurred. Elevated NSE levels were found in 16 of
these 17 patients. The highest concentrations of NSE were
measured in 7 patients with the most severe neurological
complications being transient ischemic attack and stroke.
CONCLUSIONS: The early serum levels of NSE after cardiopulmonary
bypass, in those patients with severe neurological deficits,
indicate that NSE is a suitable marker for the detection and
quantification of cerebral injury after open heart surgery.
Therefore, in addition NSE seems to be of predictive value for
the clinical outcome and gives implications for the treatment and
prognosis of patients with brain related complications in cardiac
surgery.
SOURCE: Eur J Cardiothorac Surg 1997 Apr;11(4):640-4
17
NLM CIT. ID: 97295387
TITLE: The relation between arterial oxygen tension and cerebral blood
flow during cardiopulmonary bypass.
AUTHOR: Chow G; Kirkham FJ; Edwards AD; Elliott MJ
Lloyd-Thomas A; Onoe M; Fallon P; Roberts IG
ADDRESS:
Department of Neurosciences, Institute of Child Health/Great
Ormond Street Hospital for Children, London, UK.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
7782-44-7 (Oxygen)
ABSTRACT:
OBJECTIVES: Neurological impairment occurs in up to 25% of
infants undergoing cardiopulmonary bypass with or without
circulatory arrest. Potential causes include alterations in
cerebral blood flow, hypoxia and embolisation. During
cardiopulmonary bypass, arterial oxygen tension is maintained at
levels which under normal conditions cause cerebral
vasoconstriction; this is a potential mechanism for ischaemia.
The aim of this study was to explore the relation between
arterial oxygen tension and cerebral blood flow during
cardiopulmonary bypass. METHODS: Near infrared spectroscopy was
used to explore the relation between arterial oxygen tension and
cerebral blood flow in 14 patients (median age 8 months; range 1
month to 10 years 11 months). The relations between arterial
oxygen tension, arterial carbon dioxide tension, temperature,
haematocrit, pump flow rate, mean arterial pressure and cerebral
blood flow, were examined using multivariate analysis. RESULTS:
There was no relation between cerebral blood flow and arterial
oxygen tension, but a highly significant relation was observed
between cerebral blood flow and pump flow rate, with cerebral
blood flow decreasing 4.2-fold per L.m-2.min-1 decrease of pump
flow rate. CONCLUSION: There was no relation between arterial
oxygen tension and cerebral blood flow during cardiopulmonary
bypass, but low pump flow rate may lead to reduced cerebral blood
flow.
SOURCE: Eur J Cardiothorac Surg 1997 Apr;11(4):633-9
18
NLM CIT. ID: 97287919
TITLE: Fenestrated fontan procedure: evolution of technique and
occurrence of paradoxical embolism.
AUTHOR: Quinones JA; Fisher EA; Vitullo DA; Freeman JE
Moffa SM; Cetta F; Bell TJ; Deleon SY
ADDRESS:
Department of Pediatrics, Stritch School of Medicine, Loyola
University Medical Center, 2160 S. First Avenue, Maywood, IL
60153, USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
The Fenestrated Fontan procedure (FFP) has improved outcome in
high risk patients. The technique is evolving, however, and
complications are not fully known. Over a 3-year period 13
patients (mean age 35 +/- 29 months) underwent an FFP in our
institution. In the first two patients the fenestration had to be
created because of high right atrial pressure and low cardiac
output; in 11 patients the FFP was planned. In three patients the
sutures for the adjustable fenestration were crossing the defect.
In 10 patients, purse-string sutures were placed around but not
across the defect. Because large fenestrations were created in 11
patients (8-12 mm) Glenn shunts were performed to improve
arterial saturation. The postoperative course was relatively
uneventful, with chest tubes being removed 1-8 days (mean 4 +/- 3
days) postoperatively and the hospital stay ranging from 7 to 27
days (mean 14 +/- 6 days). One patient had bleeding and another
had a mediastinal abscess. The first patient died (7.6%) because
of hemodynamic instability due to prolonged cardiopulmonary
bypass from the creation and enlargement of the fenestration. One
patient had a paradoxical cerebral embolism from clots that
formed on the sutures crossing the fenestration. Because of this
problem the remaining patients were placed on salicylates while
awaiting closure of their fenestration. All 12 patients had their
fenestrations closed, performed under local anesthesia in 9, at
mediastinal abscess drainage in 1, and spontaneously in 2. We
conclude that creation of large fenestrations in combination with
Glenn shunts and the use of adjustable fenestrations are viable
modifications of the FFP. The use of purse-string sutures around
the fenestration and antiplatelet drugs can probably minimize the
occurrence of paradoxical embolism.
SOURCE: Pediatr Cardiol 1997 May-Jun;18(3):218-21
19
NLM CIT. ID: 97276372
TITLE: Can the maze procedure be combined safely with mitral valve
repair?
AUTHOR: Izumoto H; Yagi Y; Tsuji I; Kamata J; Sasaki T
Nasu M; Kitahara H; Kawazoe K
ADDRESS:
Third Department of Surgery, Iwate Medical University, Morioka,
Japan.
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
BACKGROUND AND AIMS OF THE STUDY: The safety of combining mitral
valve repair with the maze procedure for chronic atrial
fibrillation in the surgical management of patients with mitral
valve disease is not well elucidated. We present our operative
results regarding mortality and morbidity after such combined
surgery. As a comparison, our operative results after mitral
valve repair in patients without chronic atrial fibrillation are
presented. METHODS: Between April 1993 and December 1994, 39
patients with chronic atrial fibrillation underwent mitral valve
repair and concomitant maze procedure (group 1) at the Iwate
Medical University. During the same period, 36 patients with
sinus rhythm and one patient with DDD pacemaker underwent mitral
valve repair (group 2). In order to evaluate the operative risk,
morbidity, and mortality of adding the maze procedure to mitral
valve repair, total cardiopulmonary bypass time, aortic
cross-clamp time, intraoperative blood loss, intubation period,
and duration of ICU stay were compared between the groups.
RESULTS: Total cardiopulmonary bypass time and aortic cross-clamp
time in group 1 were longer than in group 2 (174.0 +/- 38.8 min
versus 150.1 +/- 54.4 min; p = 0.032, 122.5 +/- 30.7 min versus
95.8 +/- 38.2 min; p = 0.0012). However, the duration of ICU
stay, intubation period, and intraoperative blood loss were not
different between the groups. There were no hospital deaths in
either group. Four patients in group 1, and two patients in group
2 required re-exploration for bleeding (p = NS). Two patients in
group 1, and none in group 2 required pacemaker implantation
postoperatively (p = NS). Two patients in group 2, and none in
group 2 had minor cerebral infarction (p = NS). At hospital
discharge, 28 patients in group 1 (72%) and 35 patients (97%) in
group 2 were in sinus rhythm. CONCLUSIONS: The maze procedure can
be combined with mitral valve repair without adding undue
operative risk to patients. Those patients with chronic atrial
fibrillation undergoing mitral valve repair may be advised for
the possibility of concomitant maze procedure.
SOURCE: J Heart Valve Dis 1997 Mar;6(2):166-70
20
NLM CIT. ID: 97315488
TITLE: Giant intracranial aneurysm obliteration using deep hypothermic
circulatory arrest.
AUTHOR: Zimmer DL; Martin KM
ADDRESS:
Department of Neurosurgery, Hartford Hospital, CT 06102-5037,
USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
REVIEW
REVIEW, TUTORIAL
LANGUAGE: Eng
ABSTRACT:
Giant intracranial aneurysms pose significant technical problems
for the neurosurgical team. Because of the location and structure
of these lesions, the risks associated with traditional surgical
techniques are usually unacceptable. Although aneurysm clipping
using deep hypothermic circulatory arrest was first described 30
years ago, it was nearly abandoned because of poor outcomes
associated with the systemic and cardiac complications of
extracorporeal circulation. Advances in cardiopulmonary bypass
techniques have inspired renewed interest in the use of this
method in surgery for intracranial aneurysm. Deep hypothermic
circulatory arrest, using low-flow states, has yielded
exceptional patient outcomes. This increasingly popular means of
management provides unique challenges to the neurosurgical health
care team. Understanding the pre-, intra-, and postoperative care
of these patients is imperative for neurosurgical nurses of the
twenty-first century.
SOURCE: AACN Clin Issues 1997 May;8(2):196-204
21
NLM CIT. ID: 97234988
TITLE: EEG changes during cardiopulmonary bypass surgery and
postoperative neuropsychological deficit: the effect of bubble
and membrane oxygenators.
AUTHOR: Toner I; Smith PL; Newman S; Lockwood g; Taylor KM
ADDRESS:
Department of Cardiothoracic Surgery, Royal Postgraduate Medical
School, Hammersmith Hospital, London, UK.
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL
LANGUAGE: Eng
ABSTRACT:
OBJECTIVE: Quantitative electroencephalography was used during
cardiopulmonary bypass surgery to determine the point in time of
most neuronal functional change which may result in postoperative
neuropsychological deficit. It was also used to determine any
relationship between quantitative electroencephalography changes
and type of oxygenator used in surgery. METHODS: We studied 61
coronary artery bypass graft patients. Anaesthesia included
thiopental, fentanyl and N2O. Surgery was performed with
hypothermic bypass (28 degrees C), arterial pressure of 50-70
mmHg, and alpha-stat, using bubble (Harvey 1700), or membrane
(Cobe CML) oxygenators, both with arterial line filters (Pall 40
microns). RESULTS: The main finding was a significant increase in
delta power at the end of perfusion (P < 0.01), which showed a
positive association with delta power before the start of
perfusion. Marked quantitative electroencephalography change at
the end of perfusion was not related to systemic hypotension,
temperature, type of oxygenator, bypass time, or patient age.
Intraoperative quantitative electroencephalography changes found
in most patients were transient and could not be related to
postoperative cerebral function. However, 16 of the 18 patients
who had neuropsychological deficit 2 months after surgery, also
had a significant quantitative electroencephalography change at
the end of perfusion. CONCLUSIONS: While no difference in
anaesthetic technique was found between patients, the variation
in quantitative electroencephalography power before perfusion may
indicate a difference in individual response to anaesthetic.
Usefulness of quantitative electroencephalography to predict
postoperative cerebral functional deficit remains doubtful.
SOURCE: Eur J Cardiothorac Surg 1997 Feb;11(2):312-9
22
NLM CIT. ID: 97249728
TITLE: [A case of successful surgical treatment for active endocarditis
2 days after the onset of cerebral infarction]
AUTHOR: Nakamura K; Matsuzaki Y; Hayase T; Yano Y; Araki K
Nakajima S; Kuwabara M; Onitsuka T
ADDRESS:
Second Department of Surgery, Miyazaki Medical College, Japan.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Jpn
ABSTRACT:
We performed double valve replacement for a patient with active
endocarditis 2 days after the onset of cerebral infarction
because of intractable cardiac failure. The use of heparin and
the hypotension brought by cardiopulmonary bypass can lead
exacerbation of the cerebral symptoms after open heart surgery
which is performed during acute phase of cerebral infarction.
Perfusion pressure was maintained over 70 mmHg during
cardiopulmonary bypass and activated clotting time was kept about
400 seconds to prevent aggravation of cerebral complications in
this case. The patients recovered from surgery uneventfully. We
described a case who was received double valve replacement 2 days
after the onset of cerebral infarction successfully.
SOURCE: Kyobu Geka 1997 Apr;50(4):304-7
23
NLM CIT. ID: 97182669
TITLE: The use of profound hypothermia and circulatory arrest in
operations on the thoracic aorta.
AUTHOR: Ehrlich M; Havel M; Wolner E; Laufer G; Simon P
Cartes-Zumelzu F; Luckner D; Grabenwoger M
ADDRESS:
Department of Cardio-Thoracic Surgery, University of Vienna,
Austria.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
ABSTRACT:
OBJECTIVE: This retrospective study reviews the contemporary
surgical outcome of our patients undergoing operations on
thoracic aneurysms in deep hypothermic circulatory arrest.
METHODS: Between January 1989 and February 1995, 279 patients
were operated on in our institution on various portions of the
aorta. In 143 patients (97 male, 46 female), deep hypothermia and
circulatory arrest were used as the standard operative technique.
Patients age ranged from 16 to 83 years (mean 55). Final
indication for operation was dissection Type A in 80 patients (61
acute, 19 chronic), dissection Type B in 21 patients (17 acute, 4
chronic) and atherosclerotic aneurysms in 42 patients (11 acute,
31 chronic). 16 patients were operated under preoperative
unstable hemodynamic conditions, 6 patients had been resuscitated
preoperatively. Surgical technique included cardiopulmonary
bypass with femoral artery cannulation. For added cerebral
protection all patients received Cortisone and barbiturates right
before circulatory arrest (confirmed by 0-EEG). The segment of
the aorta containing the area with the aneurysm, was resected and
replaced with a tubular albumin coated graft. RESULTS: The 30-day
mortality was 31.15% (19/61) in the acute and 23.52% (4/19) in
the chronic type A dissection group, 35.29% (6/17) in the acute
and 25% (1/4) in the chronic type B group, 36.3% (4/11) in the
acute and 22.58% (7/31) in the chronic atherosclerotic group.
Causes of postoperative death in order of frequency were:
multiorgan failure (n = 15), myocardial failure (n = 13),
bleeding (n = 4), sepsis (n = 4), myocardial infarction (n = 3)
and stroke (n = 2). CONCLUSION: Despite rather high mortality
rates in the acute aneurysm groups, the technique of profound
hypothermic circulatory arrest represents a relatively safe
method for operations on the thoracic aorta.
SOURCE: Eur J Cardiothorac Surg 1997 Jan;11(1):176-81
24
NLM CIT. ID: 97212103
TITLE: [A case report of total aortic arch replacement for distal aortic
arch aneurysm in an octogenarian]
AUTHOR: Inaoka M; Sugimoto S; Fukada J
ADDRESS:
Department of Thoracic and Cardiovascular Surgery, Hakodate
Goryoukaku Hospital, Japan.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Jpn
ABSTRACT:
A 81-year-old man was admitted to our hospital because of
hoarseness. Chest CT scan and aortogram showed distal arch
aneurysm measuring 7.5 cm in diameter. Under deep hypothermia and
selective cerebral perfusion, the distal aortic arch aneurysm was
completely replaced with a woven Dacron graft with three limbs
for the arch vessels. After the aortic cross clamp was released,
severe low output syndrome (LOS) continued because of
perioperative myocardial infarction. Then, a coronary artery
bypass grafting (CABG) to the left anterior descending artery
(LAD) was performed, after which the cardiopulmonary bypass was
easily weaned under intra-aortic balloon counterpulsation (IABP)
assistance. The postoperative course was uneventful. The
perioperative myocardial infarction was thought to be induced by
left coronary spasm, as comparison of the preoperative and
postoperative coronary arteriograms showed no change.
SOURCE: Kyobu Geka 1997 Mar;50(3):226-9
25
NLM CIT. ID: 97189188
TITLE: Changes in brain pH, PO2, PCO2, cerebral blood flow, and blood
gases induced by a hyperosmolar oxyreplete hemosubstitute during
cardiopulmonary bypass.
AUTHOR: Briceno JC; Benson CK; Mireles RZ; Howelton RV
Ybarra JR; Cruzen OG; Hantler CB; Miller OL; Calhoon JH
Korvick DL; Ottmers SE; Frisbee SE; McGinity JW; Runge TM
ADDRESS:
Biomedical Engineering Program, University of Texas at Austin,
USA.
PUBLICATION TYPES:
JOURNAL ARTICLE
LANGUAGE: Eng
REGISTRY NUMBERS:
0 (Blood Substitutes)
0 (Fluorocarbons)
124-38-9 (Carbon Dioxide)
7782-44-7 (Oxygen)
ABSTRACT:
Eleven goats (mean weight, 69 +/- 16 kg) underwent 5 hrs of
normothermic nonpulsatile cardiopulmonary bypass (CPB) using as
priming fluid either a Ringer's based crystalloid priming
solution (CP, n = 5) of a hyperosmolar oxyreplete hemosubstitute
(HS, n = 6). The HS contained 20% w/v perfluorocarbon
(perfluorodecalin), its osmolarity was 800-900 mOsm/1, and the
administered dose of perfluorocarbon was 30-50 ml/kg. Otherwise,
the experimental procedure was identical for both groups. PaCO2
was maintained above 35 mmHg and blood flow rate at 65 ml/kg.
Brain tissue pH, PO2, and PCO2, cerebral blood flow (CBF),
arterial and venous blood gases, and other systemic variables
were monitored. During CPB, PVO2 and brain tissue PO2 were
increased significantly in the HS group. The CBF per kilogram of
weight also was significantly higher in the HS group. Metabolic
acidosis developed in both groups and, surprisingly, brain tissue
pH and pHV were lower in the HS group. The mean values of PVCO2
and brain tissue PCO2 indicate that brain tissue hypercapnia also
occurred in both groups. The HS provided long-term stability and
compatibility with electrolytes, and did not cause major
complications or allergic reactions during CPB. Perfluorocarbon
based HSs improve tissue oxygenation, eliminate the risk of
infection due to homologous transfusions, do not require blood
type matching, have a shelf life longer than that of blood, and,
therefore, they can be an important factor in diminishing the
incidence of complications after CPB.
SOURCE: ASAIO J 1997 Jan-Feb;43(1):13-8
26
NLM CIT. ID: 97146391
TITLE: Aortic arch operation using selective cerebral perfusion for
nondissecting thoracic aneurysm [see comments]
AUTHOR: Hayashi J; Takamiya M; Matsuo H; Adachi S; Nakano S
Takeuchi E; Amemiya K; Yozu R; Masuda M; Tabayashi K; Komatsu S
Yasuda K; Eguchi S
COMMENTS:
Comment in: Ann Thorac Surg 1997 Jan;63(1):9-11
ADDRESS:
Niigata University School of Medicine, Japan.
PUBLICATION TYPES:
JOURNAL ARTICLE
MULTICENTER STUDY
LANGUAGE: Eng
ABSTRACT:
BACKGROUND: Risks of increasing mortality and disability in
aortic arch operations using the selective cerebral perfusion
method for nondissecting aneurysm have not yet been determined. A
multicenter, retrospective study was employed. METHODS: The
subjects were 143 patients who were admitted to one of the nine
cardiovascular centers between January 1988 and December 1993,
including 15 with ruptured aneurysm. A graft replacement of the
transverse aortic arch or distal arch was performed in 80
patients, extensive aortic reconstruction comprising simultaneous
replacement of the ascending or descending thoracic aorta (or
both) in 46, and patch repair of involved arch in 17. The mean
postoperative follow-up period was 19 months. RESULTS: Hospital
mortality was 36/143 patients (25.2%). Univariate analysis
revealed that age of 70 years or more, ruptured aneurysm, and
renal dysfunction affected hospital mortality. Neurologic
deficits were noted in 15 patients (10.5%). Reoperation was
performed in 13 patients for residual distal aneurysm or false
aneurysm. Late death occurred in 10 patients and were due to
vascular complications in 6. Multivariate analysis confirmed that
aneurysmal rupture and renal dysfunction were independent
predictors for vascular death including hospital mortality.
CONCLUSIONS: The present study confirmed that age, aneurysmal
rupture, and renal dysfunction were significant predictors for
mortality and disability in the aortic arch operation using
selective cerebral perfusion for nondissecting thoracic aneurysm.
SOURCE: Ann Thorac Surg 1997 Jan;63(1):88-92
27
NLM CIT. ID: 97146404
TITLE: Relative changes in cerebral blood flow during cardiac operations
using xenon-133 clearance versus transcranial Doppler sonography.
AUTHOR: Trivedi UH; Chambers DJ; Venn GE; Turtle MR
Patel RL
ADDRESS:
Department of Cardiac Surgical Research, Rayne Institute, St.
Thomas' Hospital, London, United Kingdom.
PUBLICATION TYPES:
CLINICAL TRIAL
JOURNAL ARTICLE
RANDOMIZED CONTROLLED TRIAL
LANGUAGE: Eng
REGISTRY NUMBERS:
0 (Xenon Radioisotopes)
ABSTRACT:
BACKGROUND: Changes in cerebral blood flow (CBF) during cardiac
operations have implications in terms of postoperative neurologic
and neuropsychological dysfunction. Current techniques of CBF
measurement are cumbersome and invasive. Transcranial Doppler
sonography offers a noninvasive means of assessing changes in
CBF. The aim of this study was validation of this technique with
existing methods of CBF measurement during cardiac operations.
METHODS: We compared the changes in CBF using xenon-133 clearance
with changes in middle cerebral artery velocity by transcranial
Doppler sonography (VMCA) using pH-stat and alpha-stat acid-base
management during cardiopulmonary bypass. Measurements were taken
(1) before bypass, (2) at 28 degrees C on bypass, (3) at 37
degrees C on bypass, and (4) after bypass. Relative changes in
CBF and VMCA, calculated as the percent change from the prebypass
baseline value normalized to 100%, were used in this analysis.
RESULTS: During the hypothermic phase of cardiopulmonary bypass,
CBF and VMCA increased by 45.9% and 51.8%, respectively (p <
0.001), during pH-stat acid-base management but decreased by only
26.4% and 22.4%, respectively (p < 0.0001), during alpha-stat
acid-base management. Linear regression analysis of the absolute
changes in CBF (mL . 100 g-1 . min-1) and VMCA (cm/s) showed a
significant correlation (r = 0.60; r2 = 0.36; p < 0.0001), but a
better correlation was obtained when relative changes in CBF and
VMCA were compared (r = 0.89; r2 = 0.79; p < 0.0001).
CONCLUSIONS: Measurements of VMCA, expressed as relative changes
of a pre-cardiopulmonary bypass level (using the noninvasive
transcranial Doppler sonographic technique), can be used to
examine CBF changes during cardiopulmonary bypass.
SOURCE: Ann Thorac Surg 1997 Jan;63(1):167-74
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