Haldenwang, P. L., Prochnow, N., Baumann, A., Schmitz, I., Christ, H., Klein, T., Haeuser, L. and Strauch, J. T. (2015). Organ protection in surgery of the aortic arch and proximal descending aorta. Z. Herz Thorax Gefasschir., 29 (6). S. 410 - 418. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1435-1277
Full text not available from this repository.Abstract
Background. Although selective cerebral perfusion (SCP) with moderate hypothermia is performed routinely in surgery of the aortic arch and proximal descending aorta, the incidence of cerebral, spinal and mesenteric ischemic injuries is still high. Objectives. The aim of these experimental studies was the evaluation of an ideal perfusion management during aortic arch replacement. In a separate clinical study risk factors for neurological injury and an adverse outcome (AO) in patients with acute type A aortic dissection (ATAAD) were analyzed. Material and methods. In an experimental setting 75 pigs (35-52 kg) were connected to an extracorporeal circulation and cooled to 25-28 degrees C. An SCP was then performed for 60-90 min under various conditions. Hemodynamic and neurophysiological data were analyzed together with the histopathological proof of ischemic organ damage. In the clinical study a logistic regression analyses was performed on 122 patients with ATAAD (mean EuroSCORE 10 +/- 3.3%) in order to detect risk factors for AO and stroke. Results and conclusion. During SCP at 25 degrees C a pump flow rate of 8-10 ml/kg body weight permin, with a resulting perfusion pressure of 40-60 mmHg provided an optimal cerebral protection. An additionally performed lower body perfusion with 20 ml/kg body weight per min at 28 degrees C maintained 50% of the physiological mesenteric blood flow and prevented mesenteric damage. In a frozen elephant trunk simulation the occlusion of all thoracic segmental arteries resulted in permanent L1-L5 spinal cord injury; therefore, in clinical practice the prosthesis length extension is crucial. Logistic regression identified a left ventricular ejection fraction (LVEF) < 30%, the presence of malperfusion, a bodymass index (BMI) > 28 kg/m(2\) as well as a lower body ischemia time > 45 min as risk factors for AO. Cannulation of the femoral artery resulted in a 4.2-fold increase in stroke frequency and should be avoided.
| Item Type: | Journal Article | ||||||||||||||||||||||||||||||||||||
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| URN: | urn:nbn:de:hbz:38-386519 | ||||||||||||||||||||||||||||||||||||
| DOI: | 10.1007/s00398-015-0030-9 | ||||||||||||||||||||||||||||||||||||
| Journal or Publication Title: | Z. Herz Thorax Gefasschir. | ||||||||||||||||||||||||||||||||||||
| Volume: | 29 | ||||||||||||||||||||||||||||||||||||
| Number: | 6 | ||||||||||||||||||||||||||||||||||||
| Page Range: | S. 410 - 418 | ||||||||||||||||||||||||||||||||||||
| Date: | 2015 | ||||||||||||||||||||||||||||||||||||
| Publisher: | SPRINGER HEIDELBERG | ||||||||||||||||||||||||||||||||||||
| Place of Publication: | HEIDELBERG | ||||||||||||||||||||||||||||||||||||
| ISSN: | 1435-1277 | ||||||||||||||||||||||||||||||||||||
| Language: | German | ||||||||||||||||||||||||||||||||||||
| Faculty: | Unspecified | ||||||||||||||||||||||||||||||||||||
| Divisions: | Unspecified | ||||||||||||||||||||||||||||||||||||
| Subjects: | no entry | ||||||||||||||||||||||||||||||||||||
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| URI: | http://kups.ub.uni-koeln.de/id/eprint/38651 |
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