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Open Access 01-12-2011 | Letters to the Editor

Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool?

Authors: Haralabos Parissis, Umar Hamid, Alan Soo, Bassel Al-Alao

Published in: Journal of Cardiothoracic Surgery | Issue 1/2011

Abstract

Antegrade selective cerebral perfusion in conjunction with hypothermia attenuate postoperative neurological injury, which in turn still remains the main cause of mortality and morbidity following aortic arch surgery. Hypothermic circulatory arrest however could be a useful tool during arch surgery, surgery for chronic thromboembolic disease, air on the arterial line during CPB, during cavotomy for extraction of renal cell carcinoma with level IV extension, or when dealing with difficult trauma to the SVC or IVC. Cerebral protective effects with hypothermic procedures including inhibition of neuron excitation, and discharge of excitable amino acids, and thereby, prevention of an increase in intercellular calcium ions, hyperoxidation of lipids in cell membranes, and free radical production.

The authors are briefly discussing the fundamental principles of using hypothermia as an adjunct tool of the cardiothoracic surgeon's practice. The relationship between temperature, flow, metabolic requirements and adverse effects is addressed.

Di Eusanio M, Schepens MAAM, Morshuis WJ, Dossche KM, Di Bartolomeo R, Pacini D, Pierangeli A, Kazui T, Ohkura K, Washiyama N: Brain protection using antegrade selective cerebral perfusion: a multicenter study. Ann Thorac Surg. 2003, 76: 1181-1189. 10.1016/S0003-4975(03)00824-5.CrossRefPubMed

Sasaki H, Ogino H, Matsuda H, Minatoya K, Ando M, Kitamura S: Integrated total arch replacement using selective cerebral perfusion: a 6-year experience. Ann Thorac Surg. 2007, 83: S805-S810. 10.1016/j.athoracsur.2006.10.094.CrossRefPubMed

Michenfelder JD, Milde JH: The effect of profound levels of hypothermia on canine cerebral metabolism. J Cereb Blood Flow Metab. 1992, 12: 877-10.1038/jcbfm.1992.120.CrossRefPubMed

Safi HJ, Brien HW, Winter JN, Thomas AC, Maulsby RL: Brain protection via cerebral retrograde perfusion during aortic aneurysm repair. Ann Thorac Surg. 1993, 56: 270-6. 10.1016/0003-4975(93)91158-J.CrossRefPubMed

Svensson LG, Nadolny EM, Penney DL: Prospective randomized neurocognitive and S-100 study of hypothermic circulatory arrest, retrograde brain perfusion, and antegrade brain perfusion for aortic arch operations. Ann Thorac Surg. 2001, 71: 1905-12. 10.1016/S0003-4975(01)02570-X.CrossRefPubMed

Okita Y, Minatoya K, Tagusari O, Ando M, Nagatsuka K, Kitamura S: Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thrac Surg. 2001, 72: 72-9. 10.1016/S0003-4975(01)02671-6.CrossRef

Lipton SA, Rosenberg PA: Excitatory amino acids as a final common pathway for neurologic disorders. N Engl J Med. 1994, 330: 613-22. 10.1056/NEJM199403033300907.CrossRefPubMed

Tseng EE, Brock MV, Kwon CC, Annanata M, Lange MS, Troncoso JC: Increased intracerebral excitatory amino acids and nitric oxide after hypothermic circulatory arrest. Ann Thorac Surg. 1999, 67: 371-6.24. 10.1016/S0003-4975(99)00033-8.CrossRefPubMed

Mault JR, Ohtake S, Klingensmith ME: Cerebral metabolism and circulatory arrest: effects of duration and strategies for protection. Ann Thorac Surg. 1993, 55: 57-10.1016/0003-4975(93)90473-U.CrossRefPubMed

10.

Greeley WJ, Ungerleider RM, Kern FH: Effects of cardiopulmonary bypass on cerebral blood flow in neonates, infants, and children. Circulation. 1989, 80: I209PubMed

11.

McCullough JN, Zhang N, Reich DL, Juvonen TS, Klein JJ: Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg. 1999, 67: 1895-9. 10.1016/S0003-4975(99)00441-5.CrossRefPubMed

12.

Dahlbacka S, Heikkinen J, Kaakinen T: pH-stat versus alpha-stat acid-base management strategy during hypothermic circulatory arrest combined with embolic brain injury. Ann Thorac Surg. 2005, 79: 316-25. 10.1016/j.athoracsur.2004.02.002.CrossRef

13.

Ehrlich MP, McCullough JN, Zhang N, Weisz DJ, Juvonen T, Bodian CA, Griepp RB: Effect of hypothermia on cerebral blood flow and metabolism in the pig. Ann Thorac Surg. 2002, 73: 191-7. 10.1016/S0003-4975(01)03273-8.CrossRefPubMed

14.

Usui A, Oohara K, Murakami F, Ooshima H, Kawamura M, Murase M: Body temperature influences regional tissue blood flow during retrograde cerebral perfusion. J Thorac Cardiovasc Surg. 1997, 114: 440-7. 10.1016/S0022-5223(97)70192-2.CrossRefPubMed

15.

Kucuker SA, Ozatik MA, Saritas A, Tasdemir O: Arch repair with unilateral antegrade cerebral perfusion. Eur J Cardiothorac Surg. 2005, 27: 638-43. 10.1016/j.ejcts.2005.01.026.CrossRefPubMed

16.

Panos A, Murith N, Bednarkiewicz M, Khatchatourov G: Axillary cerebral perfusion for arch surgery in acute type A dissection under moderate hypothermia. Eur J Cardiothorac Surg. 2006, 29: 1036-9. 10.1016/j.ejcts.2006.03.032.CrossRefPubMed

17.

Jacobs MJ, de Mol BA, Veldman DJ: Aortic arch and proximal su- praaotic arterial repair under continous antegrade cerebral perfusion and moderate hypothermia. Cardiovasc Surg. 2001, 9: 396-402. 10.1016/S0967-2109(01)00009-6.CrossRefPubMed

18.

Pacini D, Leone A, Di Marco L, Marsilli D, Sobaih F, Turci S, Masieri V, Di Bartolomeo R: Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia. Eur J Cardiothorac Surg. 2007, 31: 618-22. 10.1016/j.ejcts.2006.12.032.CrossRefPubMed

19.

Lee J, Chung C, Kang J, Choo S, Song H, Lee J: Unilateral antegrade selective cerebral perfusion in aortic surgery: clinical outcomes at different levels of hypothermia. J Korean Med Sci. 2009, 24: 807-11. 10.3346/jkms.2009.24.5.807.CrossRefPubMedPubMedCentral

20.

Kazui T, Yamashita K, Washiyama N, Terada H, Bashar AHM, Suzuki T, Ohkura K: Usefulness of antegrade selective cerebral perfusion during aortic arch operations. Ann Thorac Surg. 2002, 74: S1806-S1809. 10.1016/S0003-4975(02)04150-4.CrossRefPubMed

21.

Lazorthes G, Gouaze A, Santini JJ, Salamon G: The arterial circle of the brain (circulus arteriosus cerebri). Anat Clin. 1979, 1: 241-257. 10.1007/BF01654581.CrossRef

22.

Merkkola P, Tulla H, Ronkainen A, Soppi V, Oksala A, Koivisto T, Hippelainen M: Incomplete circle of Willis and right axillary artery perfusion. Ann Thorac Surg. 2006, 82: 74-80. 10.1016/j.athoracsur.2006.02.034.CrossRefPubMed

23.

Fassiadis N, Zayed H, Rashid H, Green DW: Invos^® Cerebral Oximeter compared with the transcranial Doppler for monitoring adequacy of cerebral perfusion in patients undergoing carotid endarterectomy. Int Angiol. 2006, 25: 401-6.PubMed

24.

Kirklin JW, Barrett-Boyes BE: Cardiac Surgery. 1993, New York, Wiley, 2-2

25.

Bachet J, Guilmet D, Goudot B: Cold cerebroplegia: a new technique of cerebral protection during operations on the transverse aortic arch. J Thorac Cardiovasc Surg. 1991, 102: 85-PubMed

26.

Matalanis G, Hata M, Buxton B: A retrospective comparative study of deep hypothermic circulatory arrest retrograde and antegrade cerebral perfusion in aortic arch surgery. Ann Thorac Cardiovasc Surgery. 2003, 9 (3): 174-9.

27.

Kazui T, Yamashita K, Washiyama N, Terada H, Bashar AHM, Suzuki K, Suzuki T: Aortic arch replacement using selective cerebral perfusion. Ann Thorac Surg. 2007, 83: S796-S798. 10.1016/j.athoracsur.2006.10.082.CrossRefPubMed

28.

Malvindi P, Scrascia G, Vitale N: Is unilateral antegrade cerebral perfusion equivalent to bilateral cerebral perfusion for patients undergoing aortic arch surgery?. ICVTS. 7 (2008): 891-897.

29.

Stecker MM, Cheung AT, Pochettino A: Deep hypothermic circulatory arrest, I: effects of cooling on electroencephalogram and evoked potentials. Ann Thorac Surg. 2001, 71: 14-10.1016/S0003-4975(00)01592-7.CrossRefPubMed

30.

Rokkas CK, Sundaresan S, Shuman TA: Profound systemic hypothermia protects the spinal cord in a primate model of spinal cord ischemia. J Thorac Cardiovasc Surgery. 1993, 106 (6): 1024-35.

31.

Khatri P, Babyak M, Croughwell ND: Temperature during coronary artery bypass surgery affects quality of life. Ann Thorac Surg. 2001, 71: 110-10.1016/S0003-4975(00)02350-X.CrossRefPubMed

32.

Fleck TM, Czerny M, Hutschala D, Koinig H, Wolner E, Grabenwoger M: The incidence of transient neurologic dysfunction after ascending aortic replacement with circulatory arrest. Ann Thorac Surg. 2003, 76: 1198-202. 10.1016/S0003-4975(03)00832-4.CrossRefPubMed

33.

Immer FF, Moser B, Krahenbuhl ES, Englberger L, Stalder M, Eckstein FS, Carrel T: Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life. Ann Thorac Surg. 2008, 85: 1614-1618. 10.1016/j.athoracsur.2007.11.027.CrossRefPubMed

34.

Reich DL, Uysal S, Sliwinski M: Neuropsychologic outcome after deep hypothermic circulatory arrest in adults. J Thorac Cardiovasc Surg. 1999, 117: 156-10.1016/S0022-5223(99)70481-2.CrossRefPubMed

35.

Svenson LG, Blackstone EH, Rajeswaran J, Sabik JF, Lytle BW: Does the arterial cannulation site for circulatory arrest influence stroke risk?. Ann Thorac Surg. 2004, 78: 1274-84. 10.1016/j.athoracsur.2004.04.063.CrossRef

36.

Ergin MA, Griepp EB, Lansman SL: Hypothermic circulatory arrest and other methods of cerebral protection during operations on the thoracic aorta. J Card Surg. 1994, 9: 525-10.1111/j.1540-8191.1994.tb00886.x.CrossRefPubMed

37.

Khaladj N, Shrestha M, Meck S, Peterss S, Kamiya H, Kallenbach K, Winterhalter M, Hoy L, Haverich A, Hagl C: 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: 908-914. 10.1016/j.jtcvs.2007.07.067.CrossRefPubMed

38.

Olsson C, Thelin S: Antegrade cerebral perfusion with a simplified technique: unilateral versus bilateral perfusion. Ann Thorac Surg. 2006, 81: 868-874. 10.1016/j.athoracsur.2005.08.079.CrossRefPubMed

39.

Apostolakis E, Akinosoglou K: The Methodologies of Hypothermic Circulatory Arrest and of Antegrade and Retrograde Cerebral Perfusion for Aortic Arch Surgery. Ann Thorac Cardiovasc Surg. 2008, 14: 138-148.PubMed

Title: Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool?
Authors: Haralabos Parissis
Umar Hamid
Alan Soo
Bassel Al-Alao
Publication date: 01-12-2011
Publisher: BioMed Central
Published in: Journal of Cardiothoracic Surgery / Issue 1/2011
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/1749-8090-6-153

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Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool?

Abstract

Keynote webinar | Spotlight on medication adherence

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Abstract

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