Neurological status in patients post retrograde cerebral perfusion, who underwent surgery on ascending aorta and arch of aorta
Semenovskiy M. L., Vavilov P. A., Akopov G. A., Tarabarko N. N.
Keywords: ascending aorta, neurologic status, retrograde cerebral perfusion, surgical therapy
Relevance. Neurologic deficit is still one of the main complications of thoracic aorta surgery. Objective. Evaluation of neurologic status, occurrence rate and nature of neurologic complications at surgeries on ascending aorta and arch of aorta, when besides hypothermal circulatory arrest, additional method of brain protection is used (antegrade or retrograde cerebral perfusion). Materials and methods. 39 operations concerning dissecting aneurysm of aorta were carried out with use retrograde cerebral perfusion (RCP) under conditions of hypothermal circulatory arrest. Intraoperative revision of aortic arch lumen defined volume of surgical intervention, which included replacement of the ascending aorta (AA) with plastic surgery on distal anastomosis under conditions of circulatory arrest, replacement of AA and partially arch of aorta, replacement of AA and arch of aorta. Average duration of RCP was 50.1±17 min at hypothermia 14°С. Average patient age is 48.5±13 years. Time of myocardial ischemia is 117±16 min. Duration of artificial blood circulation is 182±64 min. Adequacy of brain recovery was defined by recovery extubation time, and neurologic status. Results. Within hospital period, 8 (20,5 %) patients died. Lethal outcome was caused by acute cardiovascular insufficiency, bleeding, multiple organ failure. 21 (54 %), for 2 days – 5 (13 %) patients were extubated on a surgical table and on the first day. Longer ALV was with the neurologic reasons. Transient neurologic disorders (TND) were observed in 5 patients. It is important to mention that all TND events were of short-term nature and were arrested before discharge from the hospital No cases of permanent cerebrovascular disease was observed among survivor patients. Conclusion. Neurologic complications at use of RCP are seldom and transient, which is why this technique can be recommended as an option to selective antegrade cerebral perfusion.
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Semenovskiy M. L., Vavilov P. A., Akopov G. A. et al. Neurological status in patients post retrograde cerebral perfusion, who underwent surgery on ascending aorta and arch of aorta. Russian Heart Journal. 2013;12(2):88-92