Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: A prospective randomized trial
Aortic arch surgery has a high incidence of brain injury. This may in part be caused by a cerebral metabolic deficit observed after hypothermic circulatory arrest (HCA). We hypothesized that selective antegrade cerebral perfusion (SACP) would attenuate this phenomenon. In a prospective randomized tr...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2004-09, Vol.110 (11), p.231-236 |
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| creator | HARRINGTON, D. K WALKER, A. S KAUKUNTLA, H BRACEWELL, R. M CLUTTON-BROCK, T. H FAROQUI, M PAGANO, D BONSER, R. S |
| description | Aortic arch surgery has a high incidence of brain injury. This may in part be caused by a cerebral metabolic deficit observed after hypothermic circulatory arrest (HCA). We hypothesized that selective antegrade cerebral perfusion (SACP) would attenuate this phenomenon.
In a prospective randomized trial, 42 adult patients were allocated to either HCA (22) or SACP. HCA occurred at a nasopharyngeal temperature of 15 degrees C and SACP at a corporeal temperature of 25 degrees C with cerebral perfusion at 15 degrees C. Paired arterial and jugular venous samples were taken before and after arrest. Continuous transcranial Doppler monitoring of middle cerebral artery velocity (MCAV) was performed. Neuropsychometric testing was performed preoperatively and at 6 and 12 weeks postoperatively. There were 3 hospital deaths (7.1%), 2 strokes (4.8%), and 6 episodes of transient neurological deficit (14.3%). From before to after arrest, jugular bulb pO2 changed by -21.67 mm Hg (26.4) in the HCA group versus +2.27 mm Hg (18.8) in the SACP group (P=0.007). Oxygen extraction changed by +1.7 mL/dL (1.3) in the HCA group versus -1 mL/dL (2.4) in the SACP group (P |
| doi_str_mv | 10.1161/01.CIR.0000138945.78346.9c |
| format | Article |
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In a prospective randomized trial, 42 adult patients were allocated to either HCA (22) or SACP. HCA occurred at a nasopharyngeal temperature of 15 degrees C and SACP at a corporeal temperature of 25 degrees C with cerebral perfusion at 15 degrees C. Paired arterial and jugular venous samples were taken before and after arrest. Continuous transcranial Doppler monitoring of middle cerebral artery velocity (MCAV) was performed. Neuropsychometric testing was performed preoperatively and at 6 and 12 weeks postoperatively. There were 3 hospital deaths (7.1%), 2 strokes (4.8%), and 6 episodes of transient neurological deficit (14.3%). From before to after arrest, jugular bulb pO2 changed by -21.67 mm Hg (26.4) in the HCA group versus +2.27 mm Hg (18.8) in the SACP group (P=0.007). Oxygen extraction changed by +1.7 mL/dL (1.3) in the HCA group versus -1 mL/dL (2.4) in the SACP group (P<0.001). MCAV increased by 6.25 cm/s (9.1) in the HCA group and 19.2 cm/s (10.1) in the SACP group (P=0.001). Incidence of neuropsychometric deficit at 6 weeks was 6/12 (50%) in HCA patients and 8/10 (80%) in SACP patients (P=0.2), and at 12 weeks was 6/16 (38%) in HCA patients and 4/11 (36%) in SACP patients (P=1).
SACP attenuates the metabolic changes seen after HCA. Further studies are required to assess optimal perfusion conditions and clinical outcome.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.0000138945.78346.9c</identifier><identifier>PMID: 15364868</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Adult ; Aged ; Aneurysm, Dissecting - surgery ; Aorta, Thoracic - surgery ; Aortic Aneurysm - surgery ; Biological and medical sciences ; Blood and lymphatic vessels ; Blood Flow Velocity ; Brain Damage, Chronic - etiology ; Brain Damage, Chronic - prevention & control ; Carbon Dioxide - blood ; Cardiology. Vascular system ; Cerebrovascular Circulation ; Diseases of the aorta ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Heart Arrest, Induced - adverse effects ; Hematocrit ; Hospital Mortality ; Humans ; Hypothermia, Induced - adverse effects ; Hypoxia, Brain - etiology ; Hypoxia, Brain - prevention & control ; Incidence ; Male ; Medical sciences ; Middle Aged ; Middle Cerebral Artery ; Neuropsychological Tests ; Oxygen - blood ; Perfusion - methods ; Prospective Studies ; Stroke - etiology ; Stroke - prevention & control ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome ; Ultrasonography, Doppler, Transcranial ; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><ispartof>Circulation (New York, N.Y.), 2004-09, Vol.110 (11), p.231-236</ispartof><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c341t-449a9d3d7d1b624bb62c965b35a8b452da145ef03469da7ffc5ae9ad90ebc23c3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3673,27903,27904</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=16461086$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15364868$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>HARRINGTON, D. K</creatorcontrib><creatorcontrib>WALKER, A. S</creatorcontrib><creatorcontrib>KAUKUNTLA, H</creatorcontrib><creatorcontrib>BRACEWELL, R. M</creatorcontrib><creatorcontrib>CLUTTON-BROCK, T. H</creatorcontrib><creatorcontrib>FAROQUI, M</creatorcontrib><creatorcontrib>PAGANO, D</creatorcontrib><creatorcontrib>BONSER, R. S</creatorcontrib><title>Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: A prospective randomized trial</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Aortic arch surgery has a high incidence of brain injury. This may in part be caused by a cerebral metabolic deficit observed after hypothermic circulatory arrest (HCA). We hypothesized that selective antegrade cerebral perfusion (SACP) would attenuate this phenomenon.
In a prospective randomized trial, 42 adult patients were allocated to either HCA (22) or SACP. HCA occurred at a nasopharyngeal temperature of 15 degrees C and SACP at a corporeal temperature of 25 degrees C with cerebral perfusion at 15 degrees C. Paired arterial and jugular venous samples were taken before and after arrest. Continuous transcranial Doppler monitoring of middle cerebral artery velocity (MCAV) was performed. Neuropsychometric testing was performed preoperatively and at 6 and 12 weeks postoperatively. There were 3 hospital deaths (7.1%), 2 strokes (4.8%), and 6 episodes of transient neurological deficit (14.3%). From before to after arrest, jugular bulb pO2 changed by -21.67 mm Hg (26.4) in the HCA group versus +2.27 mm Hg (18.8) in the SACP group (P=0.007). Oxygen extraction changed by +1.7 mL/dL (1.3) in the HCA group versus -1 mL/dL (2.4) in the SACP group (P<0.001). MCAV increased by 6.25 cm/s (9.1) in the HCA group and 19.2 cm/s (10.1) in the SACP group (P=0.001). Incidence of neuropsychometric deficit at 6 weeks was 6/12 (50%) in HCA patients and 8/10 (80%) in SACP patients (P=0.2), and at 12 weeks was 6/16 (38%) in HCA patients and 4/11 (36%) in SACP patients (P=1).
SACP attenuates the metabolic changes seen after HCA. Further studies are required to assess optimal perfusion conditions and clinical outcome.</description><subject>Adult</subject><subject>Aged</subject><subject>Aneurysm, Dissecting - surgery</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Aneurysm - surgery</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Blood Flow Velocity</subject><subject>Brain Damage, Chronic - etiology</subject><subject>Brain Damage, Chronic - prevention & control</subject><subject>Carbon Dioxide - blood</subject><subject>Cardiology. Vascular system</subject><subject>Cerebrovascular Circulation</subject><subject>Diseases of the aorta</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Heart Arrest, Induced - adverse effects</subject><subject>Hematocrit</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Hypothermia, Induced - adverse effects</subject><subject>Hypoxia, Brain - etiology</subject><subject>Hypoxia, Brain - prevention & control</subject><subject>Incidence</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Middle Cerebral Artery</subject><subject>Neuropsychological Tests</subject><subject>Oxygen - blood</subject><subject>Perfusion - methods</subject><subject>Prospective Studies</subject><subject>Stroke - etiology</subject><subject>Stroke - prevention & control</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><subject>Ultrasonography, Doppler, Transcranial</subject><subject>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkFtLHTEURkNR6tH2L5Qg2LcZJ5PLTHyTQ72AINT2OexJ9tiUuRyTjGCf_OmNOnDykJCdtfNtFiGnrCoZU-y8YuX29mdZ5cV4q4Usm5YLVWr7iWyYrEUhJNcHZJMBXTS8ro_IcYx_81XxRn4mR0xyJVrVbsjrAw5ok39GClPCxwAOqcWAXYCB7jD0S_TzRCElnBZIGGl-8RMdMUE3D95Sh723PtFchDmkXIFg_9C4hEcMLxf0ku7CHHdrSoDJzaP_h46m4GH4Qg57GCJ-Xc8T8vvqx6_tTXF3f327vbwrLBcsFUJo0I67xrFO1aLLm9VKdlxC2wlZO2BCYl9lD9pB0_dWAmpwusLO1tzyE_L94988zNOCMZnRR4vDABPOSzRKtUo1DcvgxQdo89QxYG92wY8QXgyrzJt_UzGT_Zu9f_Pu3-i3lG9rytKN6Patq_AMnK0ARAtDn3VYH_ecEopVreL_AfYIkm8</recordid><startdate>20040914</startdate><enddate>20040914</enddate><creator>HARRINGTON, D. K</creator><creator>WALKER, A. S</creator><creator>KAUKUNTLA, H</creator><creator>BRACEWELL, R. M</creator><creator>CLUTTON-BROCK, T. H</creator><creator>FAROQUI, M</creator><creator>PAGANO, D</creator><creator>BONSER, R. S</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20040914</creationdate><title>Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: A prospective randomized trial</title><author>HARRINGTON, D. K ; WALKER, A. S ; KAUKUNTLA, H ; BRACEWELL, R. M ; CLUTTON-BROCK, T. H ; FAROQUI, M ; PAGANO, D ; BONSER, R. S</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c341t-449a9d3d7d1b624bb62c965b35a8b452da145ef03469da7ffc5ae9ad90ebc23c3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Aneurysm, Dissecting - surgery</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Aneurysm - surgery</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Blood Flow Velocity</topic><topic>Brain Damage, Chronic - etiology</topic><topic>Brain Damage, Chronic - prevention & control</topic><topic>Carbon Dioxide - blood</topic><topic>Cardiology. Vascular system</topic><topic>Cerebrovascular Circulation</topic><topic>Diseases of the aorta</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Heart Arrest, Induced - adverse effects</topic><topic>Hematocrit</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Hypothermia, Induced - adverse effects</topic><topic>Hypoxia, Brain - etiology</topic><topic>Hypoxia, Brain - prevention & control</topic><topic>Incidence</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery</topic><topic>Neuropsychological Tests</topic><topic>Oxygen - blood</topic><topic>Perfusion - methods</topic><topic>Prospective Studies</topic><topic>Stroke - etiology</topic><topic>Stroke - prevention & control</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Doppler, Transcranial</topic><topic>Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>HARRINGTON, D. K</creatorcontrib><creatorcontrib>WALKER, A. S</creatorcontrib><creatorcontrib>KAUKUNTLA, H</creatorcontrib><creatorcontrib>BRACEWELL, R. M</creatorcontrib><creatorcontrib>CLUTTON-BROCK, T. H</creatorcontrib><creatorcontrib>FAROQUI, M</creatorcontrib><creatorcontrib>PAGANO, D</creatorcontrib><creatorcontrib>BONSER, R. S</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>HARRINGTON, D. K</au><au>WALKER, A. S</au><au>KAUKUNTLA, H</au><au>BRACEWELL, R. M</au><au>CLUTTON-BROCK, T. H</au><au>FAROQUI, M</au><au>PAGANO, D</au><au>BONSER, R. S</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: A prospective randomized trial</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2004-09-14</date><risdate>2004</risdate><volume>110</volume><issue>11</issue><spage>231</spage><epage>236</epage><pages>231-236</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Aortic arch surgery has a high incidence of brain injury. This may in part be caused by a cerebral metabolic deficit observed after hypothermic circulatory arrest (HCA). We hypothesized that selective antegrade cerebral perfusion (SACP) would attenuate this phenomenon.
In a prospective randomized trial, 42 adult patients were allocated to either HCA (22) or SACP. HCA occurred at a nasopharyngeal temperature of 15 degrees C and SACP at a corporeal temperature of 25 degrees C with cerebral perfusion at 15 degrees C. Paired arterial and jugular venous samples were taken before and after arrest. Continuous transcranial Doppler monitoring of middle cerebral artery velocity (MCAV) was performed. Neuropsychometric testing was performed preoperatively and at 6 and 12 weeks postoperatively. There were 3 hospital deaths (7.1%), 2 strokes (4.8%), and 6 episodes of transient neurological deficit (14.3%). From before to after arrest, jugular bulb pO2 changed by -21.67 mm Hg (26.4) in the HCA group versus +2.27 mm Hg (18.8) in the SACP group (P=0.007). Oxygen extraction changed by +1.7 mL/dL (1.3) in the HCA group versus -1 mL/dL (2.4) in the SACP group (P<0.001). MCAV increased by 6.25 cm/s (9.1) in the HCA group and 19.2 cm/s (10.1) in the SACP group (P=0.001). Incidence of neuropsychometric deficit at 6 weeks was 6/12 (50%) in HCA patients and 8/10 (80%) in SACP patients (P=0.2), and at 12 weeks was 6/16 (38%) in HCA patients and 4/11 (36%) in SACP patients (P=1).
SACP attenuates the metabolic changes seen after HCA. Further studies are required to assess optimal perfusion conditions and clinical outcome.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>15364868</pmid><doi>10.1161/01.CIR.0000138945.78346.9c</doi><tpages>6</tpages></addata></record> |
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| subjects | Adult Aged Aneurysm, Dissecting - surgery Aorta, Thoracic - surgery Aortic Aneurysm - surgery Biological and medical sciences Blood and lymphatic vessels Blood Flow Velocity Brain Damage, Chronic - etiology Brain Damage, Chronic - prevention & control Carbon Dioxide - blood Cardiology. Vascular system Cerebrovascular Circulation Diseases of the aorta Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Heart Arrest, Induced - adverse effects Hematocrit Hospital Mortality Humans Hypothermia, Induced - adverse effects Hypoxia, Brain - etiology Hypoxia, Brain - prevention & control Incidence Male Medical sciences Middle Aged Middle Cerebral Artery Neuropsychological Tests Oxygen - blood Perfusion - methods Prospective Studies Stroke - etiology Stroke - prevention & control Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome Ultrasonography, Doppler, Transcranial Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels |
| title | Selective antegrade cerebral perfusion attenuates brain metabolic deficit in aortic arch surgery: A prospective randomized trial |
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