Skip to main content
Top
Published in: General Thoracic and Cardiovascular Surgery 1/2019

01-01-2019 | SPECIAL EDITION

Aortic arch aneurysm surgery: what is the gold standard temperature in the absence of randomized data?

Authors: Amer Harky, Mohamad Bashir, Giovanni Mariscalco

Published in: General Thoracic and Cardiovascular Surgery | Issue 1/2019

Login to get access

Abstract

In the absence randomized data for assessing the best and optimal temperature for managing open aortic arch surgery patients, cerebral protection method is still performed through hypothermic circulatory arrest with or without the use of adjuncts. A recent consensus has emerged setting to define the temperature levels. In an attempt, this was aimed to establish a solid ground for future trials in aortic arch surgery. This article reviews the current literature and the evidences behind using different temperature methods and their outcomes in patients undergoing open aortic arch surgery.
Literature
2.
go back to reference DeBakey ME, Crawford ES, Cooley DA, Morris GC Jr. Successful resection of fusiform aneurysm of aortic arch with replacement by homograft. Surg Gynecol Obstet. 1957;105:657–64. DeBakey ME, Crawford ES, Cooley DA, Morris GC Jr. Successful resection of fusiform aneurysm of aortic arch with replacement by homograft. Surg Gynecol Obstet. 1957;105:657–64.
3.
go back to reference Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975;70(6):1051–63.PubMed Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975;70(6):1051–63.PubMed
5.
go back to reference Bachet J, Guilmet D, Goudot B, Dreyfus GD, Delentdecker P, Brodaty D, et al. Antegrade cerebral perfusion with cold blood: a 13-year experience. Ann Thorac Surg. 1999;67:1874–8 (discussion 91–4).CrossRefPubMed Bachet J, Guilmet D, Goudot B, Dreyfus GD, Delentdecker P, Brodaty D, et al. Antegrade cerebral perfusion with cold blood: a 13-year experience. Ann Thorac Surg. 1999;67:1874–8 (discussion 91–4).CrossRefPubMed
6.
go back to reference Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, et al. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg. 2000;70:3–8 (discussion 8–9).CrossRefPubMed Kazui T, Washiyama N, Muhammad BA, Terada H, Yamashita K, Takinami M, et al. Total arch replacement using aortic arch branched grafts with the aid of antegrade selective cerebral perfusion. Ann Thorac Surg. 2000;70:3–8 (discussion 8–9).CrossRefPubMed
7.
go back to reference Bachet J, Guilmet D, Goudot B, Termignon JL, Teodori G, Dreyfus G, et al. Cold cerebroplegia. A new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg. 1991;102:85–93 (discussion 93–4).PubMed Bachet J, Guilmet D, Goudot B, Termignon JL, Teodori G, Dreyfus G, et al. Cold cerebroplegia. A new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg. 1991;102:85–93 (discussion 93–4).PubMed
9.
go back to reference Yan TD, Tian DH, LeMaire SA, et al. The ARCH Projects: Design and rationale (IAASSG 001). Eur J Cardiothorac Surg. 2014;45:10–6.CrossRefPubMed Yan TD, Tian DH, LeMaire SA, et al. The ARCH Projects: Design and rationale (IAASSG 001). Eur J Cardiothorac Surg. 2014;45:10–6.CrossRefPubMed
10.
go back to reference Shuhaiber JH. Evaluating the quality of trials of hypothermic circulatory arrest aortic surgery. Asian Cardiovasc Thorac Ann. 2007;15:449–52.CrossRefPubMed Shuhaiber JH. Evaluating the quality of trials of hypothermic circulatory arrest aortic surgery. Asian Cardiovasc Thorac Ann. 2007;15:449–52.CrossRefPubMed
11.
go back to reference Augoustides JG. What are the clinical questions for the optimal conduct of deep hypothermic circulatory arrest for adult aortic arch repair? J Cardiothorac Vasc Anesth. 2007;21:918–9.CrossRefPubMed Augoustides JG. What are the clinical questions for the optimal conduct of deep hypothermic circulatory arrest for adult aortic arch repair? J Cardiothorac Vasc Anesth. 2007;21:918–9.CrossRefPubMed
12.
go back to reference Urbanski PP, Lenos A, Bougioukakis P, Neophytou I, Zacher M, Diegeler A. Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm? Eur J Cardiothorac Surg. 2012;41:185–91.CrossRefPubMed Urbanski PP, Lenos A, Bougioukakis P, Neophytou I, Zacher M, Diegeler A. Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm? Eur J Cardiothorac Surg. 2012;41:185–91.CrossRefPubMed
13.
go back to reference Leshnower BG, Myung RJ, Kilgo PD, Vassiliades TA, Vega JD, Thourani VH, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion: a contemporary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg. 2010;90:547–54.CrossRefPubMed Leshnower BG, Myung RJ, Kilgo PD, Vassiliades TA, Vega JD, Thourani VH, et al. Moderate hypothermia and unilateral selective antegrade cerebral perfusion: a contemporary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg. 2010;90:547–54.CrossRefPubMed
14.
go back to reference Zierer A, Detho F, Dzemali O, Aybek T, Moritz A, Bakhtiary F. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg. 2011;91:1868–73.CrossRefPubMed Zierer A, Detho F, Dzemali O, Aybek T, Moritz A, Bakhtiary F. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg. 2011;91:1868–73.CrossRefPubMed
15.
go back to reference Luehr M, Bachetb J, Mohra FW, Etza CD. Modern temperature management in aortic arch surgery: the dilemma of moderate hypothermia. Eur J Cardiothorac Surg. 2014;45:27–39.CrossRefPubMed Luehr M, Bachetb J, Mohra FW, Etza CD. Modern temperature management in aortic arch surgery: the dilemma of moderate hypothermia. Eur J Cardiothorac Surg. 2014;45:27–39.CrossRefPubMed
16.
go back to reference Baumgartner WA, Owens SG, Cameron DE, Reitz BA. The Johns Hopkins manual of cardiac surgical care. St. Louis: Mosby; 1994. Baumgartner WA, Owens SG, Cameron DE, Reitz BA. The Johns Hopkins manual of cardiac surgical care. St. Louis: Mosby; 1994.
17.
go back to reference Ehrlich MP, McCullough JN, Zhang N, Weisz DJ, Juvonen T, Bodian CA, et al. Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg. 2002;73:191–7.CrossRefPubMed Ehrlich MP, McCullough JN, Zhang N, Weisz DJ, Juvonen T, Bodian CA, et al. Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg. 2002;73:191–7.CrossRefPubMed
18.
go back to reference Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest I: effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001;71:14–21.CrossRefPubMed Stecker MM, Cheung AT, Pochettino A, et al. Deep hypothermic circulatory arrest I: effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001;71:14–21.CrossRefPubMed
19.
go back to reference Ml Andersen J, Swaminathan ND. M, et al.: Predictors of electrocerebral silence with deep hypothermia. J Thorac Cardiovasc Surg. 2014;14:1002–7. Ml Andersen J, Swaminathan ND. M, et al.: Predictors of electrocerebral silence with deep hypothermia. J Thorac Cardiovasc Surg. 2014;14:1002–7.
20.
go back to reference Angeloni E, Benedetto U, Takkenberg JJ, et al. Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients. J Thorac Cardiovasc Surg. 2014;147:60–7.CrossRefPubMed Angeloni E, Benedetto U, Takkenberg JJ, et al. Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients. J Thorac Cardiovasc Surg. 2014;147:60–7.CrossRefPubMed
21.
go back to reference Tian DH, Wan B, Bannon PG, et al. A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion. Ann Cardiothorac Surg. 2013;2:261–70.PubMedPubMedCentral Tian DH, Wan B, Bannon PG, et al. A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion. Ann Cardiothorac Surg. 2013;2:261–70.PubMedPubMedCentral
22.
go back to reference Svensson LG, Blackstone EH, Rajeswaran J, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg. 2004;78:1274–84 (discussion 1274-84).CrossRefPubMed Svensson LG, Blackstone EH, Rajeswaran J, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg. 2004;78:1274–84 (discussion 1274-84).CrossRefPubMed
23.
go back to reference Gega A, Rizzo JA, Johnson MH, et al. Straight deep hypothermic arrest: experience in 394 patients supports its effectiveness as a sole means of brain preservation. Ann Thorac Surg. 2007;84:759–66 (discussion 766–7).CrossRefPubMed Gega A, Rizzo JA, Johnson MH, et al. Straight deep hypothermic arrest: experience in 394 patients supports its effectiveness as a sole means of brain preservation. Ann Thorac Surg. 2007;84:759–66 (discussion 766–7).CrossRefPubMed
24.
go back to reference Milewski RK, Pacini D, Moser GW, et al. Retrograde and antegrade cerebral perfusion: results in short elective arch reconstructive times. Ann Thorac Surg. 2010;89:1448–57.CrossRefPubMed Milewski RK, Pacini D, Moser GW, et al. Retrograde and antegrade cerebral perfusion: results in short elective arch reconstructive times. Ann Thorac Surg. 2010;89:1448–57.CrossRefPubMed
25.
go back to reference Lima B, Williams JB, Bhattacharya SD, et al. Results of proximal arch replacement using deep hypothermia for circulatory arrest: is moderate hypothermia really justifiable? Am Surg. 2011;77:1438–44.PubMedPubMedCentral Lima B, Williams JB, Bhattacharya SD, et al. Results of proximal arch replacement using deep hypothermia for circulatory arrest: is moderate hypothermia really justifiable? Am Surg. 2011;77:1438–44.PubMedPubMedCentral
26.
go back to reference Leshnower BG, Myung RJ, Kilgo PD, et al. Moderate hypo- thermia and unilateral selective antegrade cerebral perfusion: a con- temporary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg. 2010;90:547–54.CrossRefPubMed Leshnower BG, Myung RJ, Kilgo PD, et al. Moderate hypo- thermia and unilateral selective antegrade cerebral perfusion: a con- temporary cerebral protection strategy for aortic arch surgery. Ann Thorac Surg. 2010;90:547–54.CrossRefPubMed
27.
go back to reference Leshnower BG, Myung RJ, Thourani VH, et al. Hemiarch replacement at 28 degrees Celsius: an analysis of mild and moderate hypothermia in 500 patients. Ann Thorac Surg. 2012;93:1910–5.CrossRefPubMed Leshnower BG, Myung RJ, Thourani VH, et al. Hemiarch replacement at 28 degrees Celsius: an analysis of mild and moderate hypothermia in 500 patients. Ann Thorac Surg. 2012;93:1910–5.CrossRefPubMed
28.
go back to reference Gutsche JT, Feinman J, Silvay G, et al. Practice variations in the conduct of hypothermic circulatory arrest for adult aortic arch repair: Focus on an emerging European paradigm. Heart Lung Vessels. 2014;6:43–51.PubMed Gutsche JT, Feinman J, Silvay G, et al. Practice variations in the conduct of hypothermic circulatory arrest for adult aortic arch repair: Focus on an emerging European paradigm. Heart Lung Vessels. 2014;6:43–51.PubMed
29.
go back to reference Pacini D, Di Marco L, Leone A, et al. Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: Clinical outcomes in elderly patients. Eur J Cardiothorac Surg. 2012;42:249–53.CrossRefPubMed Pacini D, Di Marco L, Leone A, et al. Antegrade selective cerebral perfusion and moderate hypothermia in aortic arch surgery: Clinical outcomes in elderly patients. Eur J Cardiothorac Surg. 2012;42:249–53.CrossRefPubMed
30.
go back to reference Kamiya H, Hagl C, Kropivnitskaya I, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007;133:501–9.CrossRefPubMed Kamiya H, Hagl C, Kropivnitskaya I, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007;133:501–9.CrossRefPubMed
31.
go back to reference Khaladj N, Shrestha M, Meck S, et al. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg. 2008;135:908 – 14.CrossRefPubMed Khaladj N, Shrestha M, Meck S, et al. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg. 2008;135:908 – 14.CrossRefPubMed
32.
go back to reference Zierer A, Detho F, Dzemali O, et al. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg. 2011;91:1868–73.CrossRefPubMed Zierer A, Detho F, Dzemali O, et al. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg. 2011;91:1868–73.CrossRefPubMed
33.
go back to reference Leshnower BG, Thourani VH, Halkos ME, et al. Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection. Ann Thorac Surg. 2015;100:1563–8 (discussion 1568–9).CrossRefPubMed Leshnower BG, Thourani VH, Halkos ME, et al. Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type A dissection. Ann Thorac Surg. 2015;100:1563–8 (discussion 1568–9).CrossRefPubMed
34.
go back to reference Mazzeffi M, Marotta M, Lin HM, et al. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion. Ann Card Anaesth. 2012;15:266–73.CrossRefPubMed Mazzeffi M, Marotta M, Lin HM, et al. Duration of deep hypothermia during aortic surgery and the risk of perioperative blood transfusion. Ann Card Anaesth. 2012;15:266–73.CrossRefPubMed
35.
go back to reference Harrington DK, Lilley JP, Rooney SJ, et al. Nonneurologic morbidity and profound hypothermia in aortic surgery. Ann Thorac Surg. 2004;78:596–601.CrossRefPubMed Harrington DK, Lilley JP, Rooney SJ, et al. Nonneurologic morbidity and profound hypothermia in aortic surgery. Ann Thorac Surg. 2004;78:596–601.CrossRefPubMed
36.
go back to reference Cooper WA, Duarte IG, Thourani VH, et al. Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis. Ann Thorac Surg. 2000;69:696–702 (discussion 703).CrossRefPubMed Cooper WA, Duarte IG, Thourani VH, et al. Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis. Ann Thorac Surg. 2000;69:696–702 (discussion 703).CrossRefPubMed
37.
go back to reference Hagl C, Tatton NA, Khaladj N, et al. Involvement of apoptosis in neurological injury after hypothermic circulatory arrest: a new target for therapeutic intervention? Ann Thorac Surg. 2001;72:1457–64.CrossRefPubMed Hagl C, Tatton NA, Khaladj N, et al. Involvement of apoptosis in neurological injury after hypothermic circulatory arrest: a new target for therapeutic intervention? Ann Thorac Surg. 2001;72:1457–64.CrossRefPubMed
39.
go back to reference Zierer A, El-Sayed Ahmad A, Papadopoulos N, et al. Selective antegrade cerebral perfusion and mild (28–30 degrees Celsius) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients. J Thorac Cardiovasc Surg. 2012;144:1042–50.CrossRefPubMed Zierer A, El-Sayed Ahmad A, Papadopoulos N, et al. Selective antegrade cerebral perfusion and mild (28–30 degrees Celsius) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients. J Thorac Cardiovasc Surg. 2012;144:1042–50.CrossRefPubMed
40.
go back to reference Legras A, Bruzzi M, Nakashima K, et al. Colder is better during hypothermic circulatory arrest for acute type an aortic dissection. Scand Cardiovasc J. 2013;47:121–8.CrossRefPubMed Legras A, Bruzzi M, Nakashima K, et al. Colder is better during hypothermic circulatory arrest for acute type an aortic dissection. Scand Cardiovasc J. 2013;47:121–8.CrossRefPubMed
41.
go back to reference Di Eusanio M, Wesselink RM, Morshuis WJ, et al. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: a retrospective comparative study. J Thorac Cardiovasc Surg. 2003;125:849–54.CrossRefPubMed Di Eusanio M, Wesselink RM, Morshuis WJ, et al. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: a retrospective comparative study. J Thorac Cardiovasc Surg. 2003;125:849–54.CrossRefPubMed
42.
go back to reference Zierer A, Risteski P, El-Sayed Ahmad A, et al. The impact of unilateral versus bilateral antegrade cerebral perfusion on surgical outcomes after aortic arch replacement: a propensity-matched analysis. J Thorac Cardiovasc Surg. 2014;147:1212–8.CrossRefPubMed Zierer A, Risteski P, El-Sayed Ahmad A, et al. The impact of unilateral versus bilateral antegrade cerebral perfusion on surgical outcomes after aortic arch replacement: a propensity-matched analysis. J Thorac Cardiovasc Surg. 2014;147:1212–8.CrossRefPubMed
45.
go back to reference Ergin MA, Galla JD, Lansman, sL, et al. Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg. 1994;107:788–97 (discussion 797–9).PubMed Ergin MA, Galla JD, Lansman, sL, et al. Hypothermic circulatory arrest in operations on the thoracic aorta. Determinants of operative mortality and neurologic outcome. J Thorac Cardiovasc Surg. 1994;107:788–97 (discussion 797–9).PubMed
51.
go back to reference Kent WD, Herget EJ, Wong JK, Appoo JJ. Ascending, total arch, and descending thoracic aortic repair for acute DeBakey type I aortic dissection without circulatory arrest. Ann Thorac Surg. 2012;94(3):e59–61.CrossRefPubMed Kent WD, Herget EJ, Wong JK, Appoo JJ. Ascending, total arch, and descending thoracic aortic repair for acute DeBakey type I aortic dissection without circulatory arrest. Ann Thorac Surg. 2012;94(3):e59–61.CrossRefPubMed
Metadata
Title
Aortic arch aneurysm surgery: what is the gold standard temperature in the absence of randomized data?
Authors
Amer Harky
Mohamad Bashir
Giovanni Mariscalco
Publication date
01-01-2019
Publisher
Springer Japan
Published in
General Thoracic and Cardiovascular Surgery / Issue 1/2019
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-017-0867-9

Other articles of this Issue 1/2019

General Thoracic and Cardiovascular Surgery 1/2019 Go to the issue