Monitoring and Evaluation on Effect of Intraoperative Perfusion during Aortic Arch Aneurysm Surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANGXiao-long ¹ , FANGYing-hui ¹ , WANGQian ² , FUZhi-da ¹ , WEIXin-guang ¹ ,  GUANYu-long ² , YANGJiu-guang ² , JIANGFu-qing ² , SUNPeng ² , LONGCun ² , YAOJing-xin ² , LINShuan-tong ¹

1. State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R. China;
2. Department of Extracorporeal Circulation, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, P.R.China;

Corresponding author：

GUANYu-long, Email: guanyulong@yahoo.com

Keywords：

Aortic arch; Ischemia; Selective cerebral perfusion; Blood distribution; Oxygen metabolism

DOI：

10.7507/1007-4848.20160135

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To monitor the distribution of blood perfusion during aortic arch aneurysm surgery under double arterial lines with single pump. Methods We retrospectively analyzed the clinical data of 37 patients underwent aortic arch repair or reconstruction between September 2012 and April 2014. There were 9 females and 28 males at mean age of 48.1±10.8 years ranging from 19.0-72.0 years.We took double arterial lines with single pump for cardiopulmonary bypass (CPB) during the operation and we monitored the perfusion tube flow of both the upper and lower body by blood flow detector. Cerebral blood perfusion was measured by transcranial cerebral Doppler and near-infrared spectroscopy cerebral oxygen saturation (rSO₂). Results The mean CPB time of all 37 patients was 195.8±40.5 minutes ranging from 136.0-277.0 minutes and the mean duration time of selective antegrade cerebral perfusion (SCAP) was 21.6±5.6 minutes ranging from 5.0-35.0 minutes. During cooling and rewarming phases, the part of blood flow through axillary artery cannulation ranged from 31.5% to 40.8% of the whole body perfusion. The blood flow of SACP was increased to 15.0 ml / (kg·min) in 2 patients with significantly lower rSO₂ and middle cerebral artery blood flow during SACP, and they had an uneventful recovery process after surgery. There were another 2 patients recorded abnormal situation of rSO₂ without interventions. One patient died and the other one recovered with compications of spinal cord. Conclusions The technique of double arterial lines with single pump is reasonable and effective. The cerebral perfusion monitoring is helpful to detect abnormal perfusion during aortic arch aneurysm surgery.

Citation： WANGXiao-long, FANGYing-hui, WANGQian, FUZhi-da, WEIXin-guang, GUANYu-long, YANGJiu-guang, JIANGFu-qing, SUNPeng, LONGCun, YAOJing-xin, LINShuan-tong. Monitoring and Evaluation on Effect of Intraoperative Perfusion during Aortic Arch Aneurysm Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(6): 563-568. doi: 10.7507/1007-4848.20160135 Copy

1.	管玉龙, 万彩红, 董培青, 等. 直肠温度25℃时停循环选择性脑灌注的探讨. 中华胸心血管外科杂志, 2009, 25(6): 390-392.
2.	万彩红, 刘晓军, 韩敬梅, 等. 中低温选择性脑灌注对肝肾功能的影响. 中国体外循环杂志, 2010, 8(2): 75-78.
3.	Shrestha M, Martens A, Krüger H, et al. Total aortic arch replacement with the elephant trunk technique: single-centre 30-year results. Eur J Cardiothorac Surg, 2014, 45(2): 289-295.
4.	Gong M, Ma WG, Guan XL, et al. Moderate hypothermic circulatory arrest in total arch repair for acute type A aortic dissection: clinical safety and efficacy. J Thorac Dis, 2016, 8(5): 925-933.
5.	Takagi H, Umemoto T, Alice G. A Meta-analysis of total arch replacement with frozen elephant trunk in acute type a aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
6.	Garg V, Ouzounian M, Peterson MD. Advances in aortic disease management: a year in review. Curr Opin Cardiol, 2016, 31(2): 127-131.
7.	Rice RD, Sandhu HK, Leake SS, et al. Is Total arch replacement associated with worse outcomes suring repair of acute type a aortic dissection? Ann Thorac Surg, 2015, 100(6) :2159-2165.
8.	Peterson MD, Mazine A, El-Hamamsy I, et al. Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 150(4): 824-831, e1-5.
9.	Urbanski PP, Irimie V, Wagner M. Cannulation and perfusion strategy in acute aortic dissection involving both common carotid arteries. Interact Cardiovasc Thorac Surg, 2015, 21(4): 557-559.
10.	Okita Y, Matsumori M, Kano H. Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection. Eur J Cardiothorac Surg, 2016, 49(4): 1282-1284.
11.	Urbanski PP, Lenos A, Kolowca M, et al. Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion. Eur J Cardiothorac Surg, 2013, 43(6): 1140-1144.
12.	Bokeriia LA, Arakelian VS, Shchanitsyn IN, et al. First experience with monitoring somatosensory and motor evoked potential during operations on the thoracic and thoracoabdominal portions of the aorta. Angiol Sosud Khir, 2012, 18(3): 138-146.
13.	Shimizu H, Matayoshi T, Morita M, et al. Total arch replacement under flow monitoring during selective cerebral perfusion using a single pump. Ann Thorac Surg, 2013, 95(1): 29-34.
14.	Habertheuer A, Wiedemann D, Kocher A, et al. How to perfuse: concepts of cerebral protection during arch replacement. Biomed Res Int, 2015, 2015, 98: 1813.
15.	Neumann A, Koigeldiyev N, Shrestha M, et al. Complex aortic arch repair in a patient with Takayasu’s disease presenting with acute aortic dissection type Stanford A and complete collateral perfusion of the brain. Interact Cardiovasc Thorac Surg, 2016, 22(3): 384-386.
16.	Chu MW, Losenno KL, Gelinas JJ, et al. Innominate and Axillary Cannulation in Aortic Arch Surgery Provide Similar Neuroprotection. Can J Cardiol, 2016, 32(1):117-123.
17.	Agostini M, Di Gregorio V, Bertora M, et al. Near-infrared spectroscopy-detected cerebral ischemia resolved by cannulation of an axillo-femoral graft during surgical repair of type A aortic dissection.Heart Surg Forum, 2012, 15(4): E221-E223.
18.	Urbanski PP, Babin-Ebell J, Fröhner S, et al. Insufficient unilateral cerebral perfusion during emergent aortic arch surgery. Interact Cardiovasc Thorac Surg, 2012, 14(1): 122-124.
19.	张科峰, 徐东, 华扬. 经颅超声监测在主动脉夹层手术中的应用. 中国胸心血管外科临床杂志, 2011, 18(2): 146-148.
20.	Ghazy T, Darwisch A, Schmidt T, et al. Transcranial doppler sonography for optimization of cerebral perfusion in aortic arch operation. Ann Thorac Surg, 2016, 101(1): e15-e16.

1. 管玉龙, 万彩红, 董培青, 等. 直肠温度25℃时停循环选择性脑灌注的探讨. 中华胸心血管外科杂志, 2009, 25(6): 390-392.
2. 万彩红, 刘晓军, 韩敬梅, 等. 中低温选择性脑灌注对肝肾功能的影响. 中国体外循环杂志, 2010, 8(2): 75-78.
3. Shrestha M, Martens A, Krüger H, et al. Total aortic arch replacement with the elephant trunk technique: single-centre 30-year results. Eur J Cardiothorac Surg, 2014, 45(2): 289-295.
4. Gong M, Ma WG, Guan XL, et al. Moderate hypothermic circulatory arrest in total arch repair for acute type A aortic dissection: clinical safety and efficacy. J Thorac Dis, 2016, 8(5): 925-933.
5. Takagi H, Umemoto T, Alice G. A Meta-analysis of total arch replacement with frozen elephant trunk in acute type a aortic dissection. Vasc Endovascular Surg, 2016, 50(1): 33-46.
6. Garg V, Ouzounian M, Peterson MD. Advances in aortic disease management: a year in review. Curr Opin Cardiol, 2016, 31(2): 127-131.
7. Rice RD, Sandhu HK, Leake SS, et al. Is Total arch replacement associated with worse outcomes suring repair of acute type a aortic dissection? Ann Thorac Surg, 2015, 100(6) :2159-2165.
8. Peterson MD, Mazine A, El-Hamamsy I, et al. Knowledge, attitudes, and practice preferences of Canadian cardiac surgeons toward the management of acute type A aortic dissection. J Thorac Cardiovasc Surg, 2015, 150(4): 824-831, e1-5.
9. Urbanski PP, Irimie V, Wagner M. Cannulation and perfusion strategy in acute aortic dissection involving both common carotid arteries. Interact Cardiovasc Thorac Surg, 2015, 21(4): 557-559.
10. Okita Y, Matsumori M, Kano H. Direct reperfusion of the right common carotid artery prior to cardiopulmonary bypass in patients with brain malperfusion complicated with acute aortic dissection. Eur J Cardiothorac Surg, 2016, 49(4): 1282-1284.
11. Urbanski PP, Lenos A, Kolowca M, et al. Near-infrared spectroscopy for neuromonitoring of unilateral cerebral perfusion. Eur J Cardiothorac Surg, 2013, 43(6): 1140-1144.
12. Bokeriia LA, Arakelian VS, Shchanitsyn IN, et al. First experience with monitoring somatosensory and motor evoked potential during operations on the thoracic and thoracoabdominal portions of the aorta. Angiol Sosud Khir, 2012, 18(3): 138-146.
13. Shimizu H, Matayoshi T, Morita M, et al. Total arch replacement under flow monitoring during selective cerebral perfusion using a single pump. Ann Thorac Surg, 2013, 95(1): 29-34.
14. Habertheuer A, Wiedemann D, Kocher A, et al. How to perfuse: concepts of cerebral protection during arch replacement. Biomed Res Int, 2015, 2015, 98: 1813.
15. Neumann A, Koigeldiyev N, Shrestha M, et al. Complex aortic arch repair in a patient with Takayasu’s disease presenting with acute aortic dissection type Stanford A and complete collateral perfusion of the brain. Interact Cardiovasc Thorac Surg, 2016, 22(3): 384-386.
16. Chu MW, Losenno KL, Gelinas JJ, et al. Innominate and Axillary Cannulation in Aortic Arch Surgery Provide Similar Neuroprotection. Can J Cardiol, 2016, 32(1):117-123.
17. Agostini M, Di Gregorio V, Bertora M, et al. Near-infrared spectroscopy-detected cerebral ischemia resolved by cannulation of an axillo-femoral graft during surgical repair of type A aortic dissection.Heart Surg Forum, 2012, 15(4): E221-E223.
18. Urbanski PP, Babin-Ebell J, Fröhner S, et al. Insufficient unilateral cerebral perfusion during emergent aortic arch surgery. Interact Cardiovasc Thorac Surg, 2012, 14(1): 122-124.
19. 张科峰, 徐东, 华扬. 经颅超声监测在主动脉夹层手术中的应用. 中国胸心血管外科临床杂志, 2011, 18(2): 146-148.
20. Ghazy T, Darwisch A, Schmidt T, et al. Transcranial doppler sonography for optimization of cerebral perfusion in aortic arch operation. Ann Thorac Surg, 2016, 101(1): e15-e16.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Monitoring and Evaluation on Effect of Intraoperative Perfusion during Aortic Arch Aneurysm Surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content