1
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Zhang J, Wang G, Li Z, Pang G. Advanced perioperative assessment of neurological function in acute Stanford A aortic dissection. Int J Neurosci 2024:1-11. [PMID: 38682651 DOI: 10.1080/00207454.2024.2346152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/17/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE Acute Stanford Type A aortic dissection (AAAD) is a critical condition in vascular surgery, and total aortic arch replacement surgery is the preferred method to save patients' lives. In recent years, as clinical research has advanced, there has been a growing realization of the close association between poor postoperative outcomes in patients and neurological functional deficits. Neurological function monitoring is a medical technique used to evaluate and monitor the functional status of the nervous system. METHODS This monitoring involves the assessment of various aspects of the nervous system, including but not limited to nerve conduction velocity, neuromuscular function, electroencephalographic activity, and sensory nerve transmission. Neurological function monitoring has broad clinical applications and can be used to diagnose and monitor many neurological disorders, helping physicians understand patients' neurological functional status and guide treatment plans. During the postoperative recovery process, neurological function monitoring can assist physicians in assessing the potential impact of surgery on the nervous system and monitor the recovery of patients' neurological function. RESULTS Studies have shown that neurological function monitoring holds promise in predicting neurological functional prognosis and interventions for patients with aortic dissection. CONCLUSION Therefore, the primary objective of this study is to evaluate the effectiveness and reliability of various intraoperative neurological monitoring techniques, neuroimaging examinations, and biomarkers in predicting and assessing postoperative neurological outcomes in patients undergoing AAAD surgery.
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Affiliation(s)
- Jinpeng Zhang
- Department of Cardiothoracic Surgery, Jincheng People's Hospital, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Guangjun Wang
- Department of Cardiothoracic Surgery, Jincheng People's Hospital, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Zhongping Li
- Department of Critical Care Medicine, Jincheng People's Hospital, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
| | - Guofen Pang
- Department of Critical Care Medicine, Jincheng People's Hospital, Jincheng Hospital Affiliated to Changzhi Medical College, Jincheng, China
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2
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Ghia S, Savadjian A, Shin D, Diluozzo G, Weiner MM, Bhatt HV. Hypothermic Circulatory Arrest in Adult Aortic Arch Surgery: A Review of Hypothermic Circulatory Arrest and its Anesthetic Implications. J Cardiothorac Vasc Anesth 2023; 37:2634-2645. [PMID: 37723023 DOI: 10.1053/j.jvca.2023.08.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/11/2023] [Accepted: 08/20/2023] [Indexed: 09/20/2023]
Abstract
Diseases affecting the aortic arch often require surgical intervention. Hypothermic circulatory arrest (HCA) enables a safe approach during open aortic arch surgeries. Additionally, HCA provides neuroprotection by reducing cerebral metabolism and oxygen requirements. However, HCA comes with significant risks (eg, neurologic dysfunction, stroke, and coagulopathy), and the cardiac anesthesiologist must completely understand the surgical techniques, possible complications, and management strategies.
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Affiliation(s)
- Samit Ghia
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andre Savadjian
- Department of Anesthesiology and Critical Care, Duke University School of Medicine, Durham, NC
| | - DaWi Shin
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Gabriele Diluozzo
- Department of Cardiovascular Surgery, Yale School of Medicine, Bridgeport, CT
| | - Menachem M Weiner
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Himani V Bhatt
- Department of Anesthesiology, Critical Care and Perioperative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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3
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Porterie J, Hostalrich A, Dagenais F, Marcheix B, Chaufour X, Ricco JB. Hybrid Treatment of Complex Diseases of the Aortic Arch and Descending Thoracic Aorta by Frozen Elephant Trunk Technique. J Clin Med 2023; 12:5693. [PMID: 37685761 PMCID: PMC10488597 DOI: 10.3390/jcm12175693] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/10/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
The surgical management of acute and chronic complex diseases involving the aortic arch and the descending thoracic aorta remains challenging. Hybrid procedures associating total open arch replacement and stent-grafting of the proximal descending aorta were developed to allow a potential single-stage treatment, promote remodeling of the downstream aorta, and facilitate a potential second-stage thoracic endovascular aortic repair by providing an ideal landing zone. While these approaches initially used various homemade combinations of available conventional prostheses and stent-grafts, the so-called frozen elephant trunk technique emerged with the development of several custom-made hybrid prostheses. The aim of this study was to review the contemporary outcomes of this technique in the management of complex aortic diseases, with a special focus on procedural planning, organ protection and monitoring, refinements in surgical techniques, and long-term follow-up.
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Affiliation(s)
- Jean Porterie
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France;
| | - Aurélien Hostalrich
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (A.H.); (X.C.)
| | - François Dagenais
- Department of Cardiovascular Surgery, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, QC G1V 4G5, Canada;
| | - Bertrand Marcheix
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France;
| | - Xavier Chaufour
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Toulouse, 31300 Toulouse, France; (A.H.); (X.C.)
| | - Jean-Baptiste Ricco
- Department of Vascular Surgery, Centre Hospitalier Universitaire de Poitiers, 86000 Poitiers, France;
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4
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Peng L, Shi Y, Ding M, Wei W. A novel method for functional assessment of the circle of Willis before aortic arch surgery. Asian J Surg 2023; 46:3877-3878. [PMID: 37068993 DOI: 10.1016/j.asjsur.2023.03.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Affiliation(s)
- Ling Peng
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Yinhui Shi
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Meng Ding
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China
| | - Wei Wei
- Department of Anesthesiology, West China Hospital, Sichuan University, 37 Guo Xue Xiang, Chengdu, 610041, China.
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5
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Sun J, Xue C, Zhang J, Yang C, Ren K, Zhu H, Zhang B, Li X, Zhao H, Jin Z, Liu J, Duan W. Extra-anatomic revascularization and a new cannulation strategy for preoperative cerebral malperfusion due to severe stenosis or occlusion of supra-aortic branch vessels in acute type A aortic dissection. Heliyon 2023; 9:e18251. [PMID: 37539273 PMCID: PMC10395476 DOI: 10.1016/j.heliyon.2023.e18251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/05/2023] Open
Abstract
Objectives Acute type A aortic dissection (ATAAD) with severe stenosis or occlusion of the true lumen of aortic arch branch vessels often leads to an increased incidence of severe postsurgical neurological complications and mortality rate. In this study, we aimed to introduce our institutional extra-anatomic revascularization and cannulation strategy with improved postoperative outcomes for better management of patients with cerebral malperfusion in the setting of ATAAD. Methods Twenty-eight patients with ATAAD complicated by severe stenosis or occlusion of the aortic arch branch vessels, as noted on combined computed tomography angiography of the aorta and craniocervical artery, between January 2021 and June 2022 were included in this study. Basic patient characteristics, surgical procedures, hospitalization stays, and early follow-up results were analyzed. Results The median follow-up duration was 16.5 months (interquartile range: 11.5-20.5), with a 100% completion rate. The 30-day mortality rates was 7.1% (2/28 patients); two patients had multiple cerebral infarctions on preoperative computed tomography and persistent coma. Postoperative transient neurological dysfunction occurred in 10.7% (3/28) of the patients, and no new permanent neurological dysfunction occurred. Of all the patients, 3.6% (1/28) had novel acute renal failure. No other deaths, secondary surgeries, or serious complications occurred during the early follow-up period. Conclusions Use of extra-anatomic revascularization and a new cannulation strategy before cardiopulmonary bypass is safe and feasible and may reduce the high incidence of postoperative neurological complications in patients with ATAAD and cerebral malperfusion.
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Affiliation(s)
- Jingwei Sun
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Chao Xue
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jinglong Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Chen Yang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Kai Ren
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Hanzhao Zhu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Bin Zhang
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Xiayun Li
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Hongliang Zhao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Zhenxiao Jin
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Jincheng Liu
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
| | - Weixun Duan
- Department of Cardiovascular Surgery, The First Affiliated Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
- Department of Cardiovascular Surgery, Xijing Hospital, The Air Force Medical University, Xi’an, Shaanxi, China
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6
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Porterie J, Roux D, Marcheix B. Off-the-shelf bilateral antegrade cerebral perfusion: The "brain-bridge" technique. JTCVS Tech 2023; 19:12-15. [PMID: 37324342 PMCID: PMC10267808 DOI: 10.1016/j.xjtc.2023.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/15/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Jean Porterie
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Daniel Roux
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Bertrand Marcheix
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
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7
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Saltarocchi S, De Orchi P, Saade W, D'Abramo M, Chourda E, Romiti S, Vinciguerra M, Greco E, Miraldi F, Mazzesi G. Acute thrombotic occlusion of a brachiocephalic branch graft and pseudoaneurysm formation after debranching surgery for a "non-A non-B" aortic dissection. J Card Surg 2022; 37:2879-2883. [PMID: 35665963 PMCID: PMC9544199 DOI: 10.1111/jocs.16649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/26/2022] [Accepted: 05/21/2022] [Indexed: 11/26/2022]
Abstract
Non-A non-B aortic dissection is a pathology with potentially life-threatening consequences, and aortic debranching followed by thoracic endovascular aortic repair is one of the possible treatment options. Branch graft occlusion is an infrequent complication and no definite guidelines exist about postoperative antithrombotic therapy nor preoperative evaluation of individual anatomical characteristics-in particular regarding cerebral circulation-in such patients. We present the case of a 54-year-old man undergoing an aortic debranching procedure for a thoracoabdominal aortic dissection originating in the aortic arch, complicated by thrombotic occlusion of the brachiocephalic branch of the prosthesis and pseudoaneurysm of the ascending aorta, with our management and considerations.
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Affiliation(s)
- Sara Saltarocchi
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Paolo De Orchi
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Wael Saade
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Mizar D'Abramo
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Emmanouela Chourda
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Silvia Romiti
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Mattia Vinciguerra
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Ernesto Greco
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Fabio Miraldi
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Mazzesi
- Internal, Clinical, Anesthesiological and Cardiovascular Sciences Department, Sapienza University of Rome, Rome, Italy
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8
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Berger T, Kreibich M, Mueller F, Breurer-Kellner L, Rylski B, Kondov S, Schröfel H, Pingpoh C, Beyersdorf F, Siepe M, Czerny M. Risk factors for stroke after total aortic arch replacement using the frozen elephant trunk technique. Interact Cardiovasc Thorac Surg 2022; 34:865-871. [PMID: 35092274 PMCID: PMC9070457 DOI: 10.1093/icvts/ivac013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study aimed to analyse risk factors for postoperative stroke, evaluate the underlying mechanisms and report on outcomes of patients suffering a postoperative stroke after total aortic arch replacement using the frozen elephant trunk technique. METHODS Two-hundred and fifty patients underwent total aortic arch replacement via the frozen elephant trunk technique between March 2013 and November 2020 for acute and chronic aortic pathologies. Postoperative strokes were evaluated interdisciplinarily by a cardiac surgeon, neurologist and radiologist, and subclassified to each's cerebral territory. We conducted a logistic regression analysis to identify any predictors for postoperative stroke. RESULTS Overall in-hospital was mortality 10% (25 patients, 11 with a stroke). A symptomatic postoperative stroke occurred in 42 (16.8%) of our cohort. Eight thereof were non-disabling (3.3%), whereas 34 (13.6%) were disabling strokes. The most frequently affected region was the arteria cerebri media. Embolism was the primary underlying mechanism (n = 31; 73.8%). Mortality in patients with postoperative stroke was 26.2%. Logistic regression analysis revealed age over 75 (odds ratio = 3.25; 95% confidence interval 1.20-8.82; P = 0.021), a bovine arch (odds ratio = 4.96; 95% confidence interval 1.28-19.28; P = 0.021) and an acute preoperative neurological deficit (odds ratio = 19.82; 95% confidence interval 1.09-360.84; P = 0.044) as predictors for postoperative stroke. CONCLUSIONS Stroke after total aortic arch replacement using the frozen elephant trunk technique remains problematic, and most lesions are of embolic origin. Refined organ protection strategies, and sophisticated monitoring are mandatory to reduce the incidence of postoperative stroke, particularly in older patients presenting an acute preoperative neurological deficit or bovine arch.
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Affiliation(s)
- Tim Berger
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Maximilian Kreibich
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Felix Mueller
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Lara Breurer-Kellner
- Department of Neurology, Faculty of Medicine, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Stoyan Kondov
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Holger Schröfel
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Clarence Pingpoh
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Matthias Siepe
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, University Heart Centre, University Hospital Freiburg, Albert-Ludwigs-University of Freiburg, Freiburg, Germany
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Milne B, Gilbey T, Gautel L, Kunst G. Neuromonitoring and Neurocognitive Outcomes in Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth 2021; 36:2098-2113. [PMID: 34420812 DOI: 10.1053/j.jvca.2021.07.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 06/28/2021] [Accepted: 07/15/2021] [Indexed: 12/30/2022]
Abstract
Neurocognitive dysfunction after cardiac surgery can present with diverse clinical phenotypes, which include postoperative delirium, postoperative cognitive dysfunction, and stroke, and it presents a significant healthcare burden for both patients and providers. Neurologic monitoring during cardiac surgery includes several modalities assessing cerebral perfusion and oxygenation (near-infrared spectroscopy, transcranial Doppler and jugular venous bulb saturation monitoring) and those that measure cerebral function (processed and unprocessed electroencephalogram), reflecting an absence of a single, definitive neuromonitor. This narrative review briefly describes the technologic basis of these neuromonitoring modalities, before exploring their use in clinical practice, both as tools to predict neurocognitive dysfunction, and with a bundle of interventions designed to optimize cerebral oxygen supply, with the aim of reducing postoperative delirium and cognitive dysfunction following cardiac surgery.
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Affiliation(s)
- Benjamin Milne
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Thomas Gilbey
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK
| | - Livia Gautel
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Biological Sciences in Edinburgh, University of Edinburgh, Edinburgh, UK; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK
| | - Gudrun Kunst
- Department of Anaesthetics and Pain Medicine, King's College Hospital NHS Foundation Trust, London, UK; School of Cardiovascular Medicine & Sciences, King's College London British Heart Foundation Centre of Excellence, London, UK.
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10
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Wu TC, Chen TY, Ko CC, Chen JH, Lin CP. Correlation of internal carotid artery diameter and carotid flow with asymmetry of the circle of Willis. BMC Neurol 2020; 20:251. [PMID: 32563264 PMCID: PMC7305584 DOI: 10.1186/s12883-020-01831-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 06/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background The purpose of this study was to clarify the effect of asymmetric COW variants on carotid flow changes, and proposed an easy estimate of the representative carotid flow volume for accurate numerical simulation. Methods A total of 210 healthy adults receiving magnetic resonance angiography and carotid duplex sonography were included. Three anterior cerebral artery asymmetry (AA) groups were defined based on the diameter ratio difference (DRD) of bilateral A1 segments: AA1 group, one-side A1 aplasia; AA2, A1 DRD ≥ 50%; AA3, A1 DRD between 10 and 50%. Similarly, 3 posterior communicating artery (PcomA) asymmetry (PA) groups were defined: PA1 group, one fetal-origin posterior cerebral artery and absent contralateral PcomA; PA2, PcomA DRD ≥ 50%; PA3, PcomA DRD between 10 and 50%. Results With A1 asymmetry, the ICA diameter of the dominant A1 is significantly greater than the contralateral side. Significant differences of bilateral ICA flow were present in the AA1 and AA2 groups (mean flow difference 42.9 and 30.7%, respectively). Significant bilateral ICA diameter and flow differences were only found in the PA1 group. Linear regression analysis of ICA diameter and flow found a moderately positive correlation between ICA diameter and flow in all AA groups, with a 1 mm increment in vessel diameter corresponding to a 62.6 ml increment of flow volume. The product of bilateral ICA diameter and flow volume difference (ICA-PDF) could be a potential discriminator with a cutoff of 4.31 to predict A1 asymmetry ≥50% with a sensitivity of 0.81 and specificity of 0.76. Conclusions The study verifies that A1 asymmetry causes unequal bilateral carotid inflow, and consequently different bilateral ICA diameters. Adjustment of the inflow boundary conditions according to the COW variants would be necessary to improve the accuracy of numerical simulation.
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Affiliation(s)
- Te-Chang Wu
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan. .,Department of Medical Sciences Industry, Chang Jung Christian University, Tainan, Taiwan. .,Department of Medical Imaging, Chi-Mei Medical Center, Tainan City, Taiwan.
| | - Tai-Yuan Chen
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan City, Taiwan.,Graduate Institute of Medical Sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan City, Taiwan.,Center of General Education, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jeon-Hor Chen
- Department of Radiology, E-DA Hospital, E-DA Cancer Hospital, I-Shou University, Kaohsiung, Taiwan.,Center for Functional Onco-Imaging of Radiological Sciences, School of Medicine, University of California, Irvine, California, USA
| | - Ching-Po Lin
- Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan.,Institute of Neuroscience, School of Life Science, National Yang-Ming University, Taipei, Taiwan
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11
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Haunschild J, Borger MA, Etz CD. Zerebrale Protektionsstrategien und Monitoring im hypothermen Kreislaufstillstand. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2019. [DOI: 10.1007/s00398-019-00340-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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12
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Smith T, van der Weijde E, Heijmen RH. Surgical debranching for endovascular arch penetrating ulcer management. Ann Cardiothorac Surg 2019; 8:512-515. [PMID: 31463218 DOI: 10.21037/acs.2019.06.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Tim Smith
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Emma van der Weijde
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Robin H Heijmen
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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13
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Intraoperatives Monitoring in der konventionellen und endovaskulären Aortenchirurgie – Neue Verfahren. GEFÄSSCHIRURGIE 2019. [DOI: 10.1007/s00772-019-00562-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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14
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Etz CD, Borger MA. Commentary: Functional assessment of circle of Willis-interesting observation or critical consideration? J Thorac Cardiovasc Surg 2019; 158:1305-1306. [PMID: 30853222 DOI: 10.1016/j.jtcvs.2019.01.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Christian D Etz
- University Clinic of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Michael A Borger
- University Clinic of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany.
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