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Liebrich M, Schweder M, Seeburger J, Voth V. Triple-Arterial Cannulation Approach for Whole-Body Perfusion in Infant Hypoplastic Aortic Arch and Coarctation Repair. Thorac Cardiovasc Surg Rep 2022; 11:e47-e49. [PMID: 36032934 PMCID: PMC9402288 DOI: 10.1055/s-0042-1750428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 04/04/2022] [Indexed: 11/06/2022] Open
Abstract
Organ and end-organ protection in aortic arch surgery represents a substantial challenge, especially in infants. Selective antegrade cerebral perfusion has been reported to improve organ function during this procedure. Visceral perfusion can be optimized by cannulation of the descending aorta during infant aortic arch surgery, leading to a decrease in end organ damage. However, it is associated with extensive surgical manipulation and subsequent risk of major vessel and potential organ damage. In this report, we describe a technique for distal body perfusion in an infant with hypoplastic aortic arch and isthmus stenosis by ultrasound-guided cannulation of the femoral artery using an intra-arterial vascular sheath establishing whole-body perfusion by triple cannulation.
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Affiliation(s)
- Markus Liebrich
- Departement of Cardiac Surgery, Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Baden-Württemberg, Germany
| | - Marco Schweder
- Departement of Cardiac Surgery, Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Baden-Württemberg, Germany
| | - Joerg Seeburger
- Departement of Cardiac Surgery, Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Baden-Württemberg, Germany
| | - Vladimir Voth
- Departement of Cardiac Surgery, Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Baden-Württemberg, Germany
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Huang CH, Wang YC, Chou HW, Huang SC. Near-Infrared Spectroscopy Assessment of Tissue Oxygenation During Selective Cerebral Perfusion for Neonatal Aortic Arch Reconstruction. Front Med (Lausanne) 2021; 8:637257. [PMID: 33996851 PMCID: PMC8119641 DOI: 10.3389/fmed.2021.637257] [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: 12/03/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Optimal selective cerebral perfusion (SCP) management for neonatal aortic arch surgery has not been extensively studied. We induced mild hypothermia during SCP and used the tissue oxygenation monitor to ensure adequate perfusion during the cardiopulmonary bypass (CPB). Methods: Eight cases were recruited from September 2018 to April 2020. SCP was maintained at 30°C, and CPB was adjusted to achieve a mean right radial artery pressure of 30 mmHg. The near-infrared tissue saturation (NIRS) monitor was applied to assess the right and left brain, flank, and lower extremity during the surgery. Results: During surgery, the mean age was 4.75 days, the mean body weight was 2.92 kg, the CPB duration was 86.5 ±18.7 min, the aortic cross-clamp time was 46.1 ± 12.7 min, and the SCP duration was 14.6±3.4 min. The brain NIRS before, during, and after SCP was 64.2, 67.2, and 71.5 on the left side and 67.9, 66.2, and 70.1 on the right side (p = NS), respectively. However, renal and lower extremity tissue oxygenation, respectively decreased from 61.6 and 62.4 before SCP to 37.7 and 39.9 after SCP (p < 0.05) and then increased to 70.1 and 90.4 after full body flow resumed. No stroke was reported postoperatively. Conclusion: SCP under mild hypothermia can aid in efficient maintenance of brain perfusion during neonatal arch reconstruction. The clinical outcome of this strategy was favorable for up to 20 min, but the safety duration of lower body ischemia warrants further analysis.
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Affiliation(s)
- Chi-Hsiang Huang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chia Wang
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
| | - Hen-Wen Chou
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Chien Huang
- Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
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Baehner T, Breuer J, Heinze I, Duerr GD, Dewald O, Velten M. Low-body-perfusion via an arterial sheath reduces inflammation after aortic arch reconstruction surgery. EUR J INFLAMM 2021. [DOI: 10.1177/20587392211000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pediatric cardiac surgeries involving aortic arch reconstruction are complex and require long cardiopulmonary bypass (CPB) times with deep hypothermic circulatory arrest (DHCA). Selective perfusion techniques have been developed to prevent the deleterious consequences of DHCA associated hypoperfusion. The effectivity of low body perfusion through cannulation of the femoral artery with an arterial sheath remains to be elucidated. We compared perfusion and inflammation in patients receiving selective antegrade cerebral perfusion (ACP) only to low body perfusion (LBP) in addition to ACP during DHCA for aortic arch reconstruction surgery. There was no difference in patient characteristics, cardiac pathologies, or performed procedures between ACP and LBP groups. Lactate levels increased after cardiac arrest in both groups. However, lactate levels were lower after 1 h reperfusion, at the end of extracorporeal circulation (ECC), and after surgery in LBP group compared to ACP only. Furthermore, creatinine was increased in ACP group on postoperative day 1 compared to LBP group but no acute kidney injury was observed in any group. IL-6 concentration increased in ACP group, while remained unchanged in LBP group compared to pre surgical values and were significantly lower compared to ACP group on postoperative days 1 and 2. LBP via an arterial sheath during cardiac arrest for aortic arch reconstruction surgery in addition to ACP, improves post ECC tissue perfusion as indicated by lower lactate levels and reduces creatinine levels suggesting milder kidney injury. LBP seems to prevent postoperative inflammation through a reduction in procedural duration or enhanced perfusion and thereby improves the outcome after aortic arch reconstruction surgery.
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Affiliation(s)
- Torsten Baehner
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
- Department of Anesthesiology, St. Nikolaus Hospital, Andernach, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Ingo Heinze
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | | | - Oliver Dewald
- Department of Cardiac Surgery, University Medical Center Oldenburg, Oldenburg, Niedersachsen, Germany
| | - Markus Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
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Beating heart thoracic aortic surgery under selective myocardial perfusion for patients with congenital aortic anomalies. Gen Thorac Cardiovasc Surg 2020; 68:956-961. [PMID: 32034678 DOI: 10.1007/s11748-020-01304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 01/24/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE We evaluated beating heart thoracic aortic surgery (BHTAS) using selective myocardial perfusion (SMP) in patients with aortic anomalies with complex surgical needs. METHODS Between 2012 and 2018, 27 infants with aortic anomalies underwent BHTAS using SMP. RESULTS Median body weight was 3.5 kg (range 2.6-5.2). In total, 15 cases of aortic coarctation, 7 cases of hypoplastic left heart syndrome, and 5 cases of interrupted aortic arch were included. An extended aortic arch anastomosis maneuver was used in 7 cases and aortic arch reconstruction compensated with an autologous pericardium patch was used in 6 cases. A Norwood-type procedure was used in 11 cases. The median Aristotle comprehensive score was 13.9 (7.0-20.0). BHTAS cases were not inferior in postoperative CK-MB/CK ratio (12.4 ± 2.8 in BHTAS vs 13.9 ± 3.6 in CTAS, p = 0.09), and there were no instances of myocardial ischemia. Two late deaths occurred due to shunt obstruction (n = 1) and valve malfunction (n = 1). Freedom from aortic reintervention was not inferior to conventional thoracic aortic surgery. BHTAS cases exhibited shorter cardiac arrest time than that of conventional thoracic aortic surgery in similar surgical procedures [CoA/VSD cases: 48.0 ± 8.0 min in the BHTAS cases and 65.7 ± 10.8 min in the CTAS cases (p = 0.0122), simple CoA/re-CoA cases: 0 min in the BHTAS cases and 20.1 ± 3.6 min in the CTAS cases]. CONCLUSIONS BHTAS reduced cardioplegic arrest time while maintaining postoperative CK-MB/CK ratio, mid-term death, and aortic reintervention rates.
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Boburg RS, Rosenberger P, Kling S, Jost W, Schlensak C, Magunia H. Selective lower body perfusion during aortic arch surgery in neonates and small children. Perfusion 2020; 35:621-625. [PMID: 31960747 PMCID: PMC7536511 DOI: 10.1177/0267659119896890] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Aortic arch reconstruction surgery represents a challenge for the medical
personnel involved in treatment. Along the years, the perfusion strategies
for aortic arch reconstruction have evolved from deep hypothermic cardiac
arrest to antegrade cerebral perfusion with moderate hypothermia, and
recently to a combined cerebral and lower body perfusion with moderate
hypothermia. To achieve a lower body perfusion, several cannulation
strategies have been described. In this study, we investigated the
feasibility of utilizing an arterial sheath introduced in the femoral artery
to achieve an effective lower body perfusion. Methods: We included patients who underwent an aortic arch reconstruction surgery with
a lower body perfusion, from January 2017 to June 2019. To achieve a lower
body perfusion, a three-way stopcock was connected to the arterial line,
where one end was connected to the central cannulation for cerebral
perfusion and the other to an arterial sheath that was introduced through
the femoral artery. A total of 25 patients were included. Peri- and
postoperative lactate and creatinine levels and signs of malperfusion were
recorded. Results: During the reperfusion phase, after selective perfusion ended none of the
patients showed a significant increase in lactate, creatinine, and liver
enzyme levels. After 24 hours, there were no signs of an acute kidney
injury, femoral vessel injury, or limb malperfusion. Conclusion: These findings show that a sufficient lower body perfusion through an
arterial sheath placed in the femoral artery for aortic arch reconstruction
can be achieved. This approach caused no complications related to the
arterial sheath during the early postoperative period and is an easy way to
maintain perfusion of systemic organs.
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Affiliation(s)
- Rodrigo Sandoval Boburg
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Steffen Kling
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Walter Jost
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
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Kulyabin YY, Gorbatykh YN, Soynov IA, Zubritskiy AV, Voitov AV, Bogachev-Prokophiev AV. Selective Antegrade Cerebral Perfusion With or Without Additional Lower Body Perfusion During Aortic Arch Reconstruction in Infants. World J Pediatr Congenit Heart Surg 2019; 11:49-55. [PMID: 31835988 DOI: 10.1177/2150135119885887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Aortic arch reconstruction is often challenging, especially in infants, owing to its high postoperative complication risks. This study aimed to compare the effectiveness between selective antegrade cerebral perfusion (SACP) alone and SACP in combination with continuous lower body perfusion with descending aortic cannulation (DAC) in preserving renal function, and to determine the influence of perfusion strategy on the postoperative course of infants who underwent aortic arch reconstruction. MATERIAL AND METHODS A total of 121 infants who underwent aortic arch reconstruction between January 2008 and December 2018 were included in the analysis. Patients (median age: 29 days, range: 3-270 days) were divided into the following groups: those who underwent repair with SACP (SACP group, 79 patients) and those who underwent additional lower body perfusion (DAC group, 42 patients). RESULTS Three (7.1%) and nine (11.4%) patients died in the DAC and SACP groups, respectively (P = .54). The SACP group had more patients requiring renal replacement therapy (P = .002) and higher incidence of second stage acute kidney injury (AKI) development (Kidney disease improving global outcomes (KDIGO) criteria; P = .032). The SACP group had higher frequency of open chest postoperatively than the DAC group (P = .011). The DAC group had lower vasoactive inotropic score (VIS) at the first postoperative day (P < .001) and shorter intensive care unit length of stay (P = .050). There was no difference in neurological complications between the groups (P = .061). High VIS was associated with early mortality (odds ratio [OR]: 1.79 [1.33-2.41], P < .001) and AKI (OR: 1.60 [1.35-1.91], P < .001). The DAC perfusion strategy with minimal hypothermia was associated with lower risk of AKI (OR: 0.91 [0.84-0.98], P = .016). CONCLUSION Antegrade cerebral perfusion with continuous lower body perfusion via DAC could effectively be used for improving early postoperative results among infants undergoing procedures that include aortic arch reconstruction.
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Affiliation(s)
- Yuriy Y Kulyabin
- Department of Pediatric Cardiac Surgery, National Medical Research Center, Novosibirsk, Russia
| | - Yuriy N Gorbatykh
- Department of Pediatric Cardiac Surgery, National Medical Research Center, Novosibirsk, Russia
| | - Ilya A Soynov
- Department of Pediatric Cardiac Surgery, National Medical Research Center, Novosibirsk, Russia
| | - Alexey V Zubritskiy
- Department of Pediatric Cardiac Surgery, National Medical Research Center, Novosibirsk, Russia
| | - Alexey V Voitov
- Department of Pediatric Cardiac Surgery, National Medical Research Center, Novosibirsk, Russia
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Tong Y, Zhang P, Li S, Yan J, Feng Z, Zhao J, Guo S, Jin Y, Liu J. Perioperative blood product transfusion of two different perfusion strategies on pediatric patients undergoing aortic arch surgery. Artif Organs 2019; 44:40-49. [PMID: 31315148 DOI: 10.1111/aor.13539] [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: 04/19/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/30/2022]
Abstract
Simple regional cerebral perfusion (SRCP) or cerebro-myocardial perfusion (CMP) is selectively used in one-stage complex aortic arch malformation repair. This analysis was performed to investigate the effect of CMP and SRCP on perioperative blood product consumption, and to evaluate whether these two strategies have different effects on the clinical outcomes. A retrospective analysis of 284 children with complicated aortic malformation from January 2010 to June 2018 was performed. The overall cohort was divided into SRCP group (n = 202) and CMP group (n = 82). A comprehensive comparison of perioperative blood product consumption-related indexes was performed. Cardiopulmonary bypass time, cardiac arrest time, cooling, and rewarming time in the CMP group were significantly shorter than those in the SRCP group (P < .05). Chest tube time was 3.82 ± 1.33 days in the SRCP group compared to 3.42 ± 0.97 days in the CMP group (P = .005). Moreover, intraoperative platelet (PLT) transfusion volume (mL/kg) and rate (%) were significantly lower in the CMP group (P < .001). Multivariate regression analysis found that intraoperative PLT transfusion was significantly negatively correlated with CMP management [OR = 0.237 (0.110-0.507), P < .001] and CPB time was independently associated with delayed chest tube removal (>3 days) [OR = 1.010 (1.001-1.020), P = .031]. In-hospital mortality and early postoperative adverse events were not significantly different between the two groups. In children with on-pump complex aortic arch surgeries, CMP is more preferable than SRCP in blood protection. However, overall prognosis was not remarkably different between these two perfusion groups. They are both safe and feasible.
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Affiliation(s)
- Yuanyuan Tong
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Peiyao Zhang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shoujun Li
- State Key Laboratory of Cardiovascular Disease, Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Yan
- State Key Laboratory of Cardiovascular Disease, Pediatric Cardiac Surgery Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhengyi Feng
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ju Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengwen Guo
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Jin
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jinping Liu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiopulmonary Bypass, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Malchesky PS. Artificial Organs 2018: A Year in Review. Artif Organs 2019; 43:288-317. [PMID: 30680758 DOI: 10.1111/aor.13428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 01/22/2019] [Indexed: 12/24/2022]
Abstract
In this Editor's Review, articles published in 2018 are organized by category and summarized. We provide a brief reflection of the research and progress in artificial organs intended to advance and better human life while providing insight for continued application of these technologies and methods. Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level." Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. Peer-reviewed special issues this year included contributions from the 13th International Conference on Pediatric Mechanical Circulatory Support Systems and Pediatric Cardiopulmonary Perfusion edited by Dr. Akif Undar, and the 25th Congress of the International Society for Mechanical Circulatory Support edited by Dr. Marvin Slepian. Additionally, many editorials highlighted the worldwide survival differences in hemodialysis and perspectives on mechanical circulatory support and stem cell therapies for cardiac support. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide meaningful suggestions to the author's work whether eventually accepted or rejected. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, John Wiley & Sons for their expert attention and support in the production and marketing of Artificial Organs. We look forward to reporting further advances in the coming years.
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