Vol. 20 No. 4 (2016)
ORIGINAL ARTICLES: AORTIC ARCH SURGERY

Change of paradigm in the aortic arch reconstruction – “warm head – cool body”

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  • E. Rosseykin,
  • M. Evdokimov,
  • V. Bazylev,
  • P. Batrakov,
  • E. Kobzev,
  • T. Gebgart
E. Rosseykin
Federal Center for Cardiovascular Surgery, Ministry of Health Care of Russian Federation (Penza), 440071, Penza, Russian Federation
M. Evdokimov
Federal Center for Cardiovascular Surgery, Ministry of Health Care of Russian Federation (Penza), 440071, Penza, Russian Federation
V. Bazylev
Federal Center for Cardiovascular Surgery, Ministry of Health Care of Russian Federation (Penza), 440071, Penza, Russian Federation
P. Batrakov
Federal Center for Cardiovascular Surgery, Ministry of Health Care of Russian Federation (Penza), 440071, Penza, Russian Federation
Bio
E. Kobzev
Federal Center for Cardiovascular Surgery, Ministry of Health Care of Russian Federation (Penza), 440071, Penza, Russian Federation
T. Gebgart
Federal Center for Cardiovascular Surgery, Ministry of Health Care of Russian Federation (Penza), 440071, Penza, Russian Federation
DOI: https://doi.org/10.21688/1681-3472-2016-4-26-33

Published 2016-12-30

Keywords

  • aortic aneurysm,
  • aortic dissection,
  • total reconstruction of the aortic arch,
  • selective antegrade cerebral perfusion,
  • normothermic perfusion

How to Cite

Rosseykin, E., Evdokimov, M., Bazylev, V., Batrakov, P., Kobzev, E., & Gebgart, T. (2016). Change of paradigm in the aortic arch reconstruction – “warm head – cool body”. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 20(4), 26–33. https://doi.org/10.21688/1681-3472-2016-4-26-33

Copyright (c) 2016 Rosseykin E.V., Evdokimov M.E., Bazylev V.V., Batrakov P.A., Kobzev E.E., Gebgart T.V.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. The article focuses on the immediate outcomes of a new technology implemented in total reconstruction of the aortic arch and its branches.
Methods. From January 2014 to July 2016 56 patients underwent aortic arch reconstruction by the proposed new technology. The age was from 23 till 73 years (median 57,5). Indications for aortic arch reconstruction were an aneurysm of the aortic arch (32 patients, 57 %), acute (8 patients, 14 %) and DeBakey Types 1 and 2 chronic dissection (16 patients, 29 %). The proposed technology of aortic arch reconstruction included four interrelated components: 1) total individual antegrade cerebral perfusion in the normothermic mode; 2) a system of two independent circuits of perfusion; 3) original method of prosthetic aortic arch branches in reverse order (“Opposite Branch First Technique”); 4) Penza aortic cannulation technique (“Penza Cannulation”).
Results. No in-hospital mortality was observed. There were two cases of neurological deficit in the immediate postoperative period, associated with atrial fibrillation. CPB time was 177.5 (92-312) minutes. The time of ASCP was 145 (78-220) min. Intraoperative blood loss was 626.5 (300-3200) ml. Patients were extubated 8.9 (3.6-106.8) hours after surgery and held 3 (2-23) days in ICU.
Conclusion. The proposed technology of aortic arch reconstruction is a radical, universal and individual method. It shows good clinical results without in-hospital mortality. This method allows for using the technique of “open distal anastomosis” simultaneously with normothermic cerebral perfusion.

Received 26 October 2016. Accepted 14 December 2016.

Funding: The study had no sponsorship.
Conflict of interest: The authors declare no conflict of interest.
Author contributions
Conceptualization and study design: Rosseykin E.V., Evdokimov M.E., Bazylev V.V.
Material acquisition and analysis: Evdokimov M.E., Batrakov P.A., Gebgart T.V.
Statistical data processing: Evdokimov M.E., Batrakov P.A., Kobzev E.E.
Article writing: Evdokimov M.E., Batrakov P.A.
Review & editing: Evdokimov M.E., Rosseykin E.V., Bazylev V.V.

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References

  1. Cooley D, DeBakey M, Morris G Jr. Controlled extracorporeal circulation in surgical treatment of aortic aneurysm. Annals of Surgery. 1957;146(3):473-85.
  2. Harrington D, Fragomeni F, Bonser R. Cerebral perfusion. Ann Thorac Surg. 2007;83(2):S799-804. http://dx.doi.org/10.1016/j.athoracsur.2006.11.018
  3. De Paulis R, Czerny M, Weltert L, Bavaria J, Borger MA, Carrel TP, Etz CD, Grimm M, Loubani M, Pacini D, Resch T, Urbanski PP, Weigang E, EACTS Vascular Domain Group. Current trends in cannulation and neuroprotection during surgery of the aortic arch in Europe. Eur J Cardiothorac Surg. 2015;47(5):917-23. http://dx.doi.org/10.1093/ejcts/ezu284
  4. Urbanski P, Luehr M, Di Bartolomeo R, Diegeler A, De Paulis R, Esposito G, Bonser RS, Etz CD, Kallenbach K, Rylski B, Shrestha ML, Tsagakis K, Zacher M, Zierer A. Multicentre analysis of current strategies and outcomes in open aortic arch surgery: heterogeneity is still an issue. Eur J Cardiothorac Surg. 2016;50(2):249-55. http://dx.doi.org/10.1093/ejcts/ezw055
  5. Chernyavskiy AM, Alsov SA, Lyashenko MM, Sirota DA, Khvan DS, Vinogradova TYe, Lomivorotov VV, Zakharov SL. The analyze of neurological complications after aortic arch reconstruction in patients with proximal aortic dissection. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2013;17(2):35-40. (In Russ.)
  6. Akselrod BA, Guskov DA, Charchyan ER, Fedulova SV, Oystrakh AS, Eremenko AA, Lokshin LS, Khachatryan ZR, Medvedeva LA, Trekova NA. Anaesthetic management of reconstructive surgery on the aortic arch: the nuances of organ protection. Anesteziologiya i Reanimatologiya. 2015;60(5):26-31. (In Russ.)
  7. Griepp R, Stinson E, Hollingsworth J, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg. 1975;70(6):1051-63.
  8. Griepp R, Ergin M, McCullough J, Nguyen KH, Juvonen T, Chang N, Griepp EB. Use of hypothermic circulatory arrest for cerebral protection during aortic surgery. J Cardiovasc Surg. 1997;12(2 Suppl):312-21.
  9. Di Eusanio M, Schepens M, Morshuis W, 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(4):1181-8.
  10. Kamiya H, Hagl C, Kropivnitskaya I, Böthig D, Kallenbach K, Khaladj N, Martens A, Haverich A, Karck M. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007;133(2):501-9. http://dx.doi.org/10.1016/j.jtcvs.2006.09.045
  11. 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(4):618-22. http://dx.doi.org/10.1016/j.ejcts.2006.12.032
  12. Bechtel JFM, Eleftheriadis S, Sievers H-H. Surgical strategies for neuroprotection during ascending aortic and arch surgery. Applied Cardiopulmonary Pathophysiology. 2009;13:219-23.
  13. Rosseykin EV, Evdokimov ME, Bazylev VV, Vachev SA. Method for determining volume rate of regional blood flow for carrying out selective antegrade perfusion. Russian Patent. No. 2596059 C2. (In Russ.)
  14. Takano H, Sakakibara T, Matsuwaka R, Hori T, Sakagoshi N, Shinohara N. The safety and usefulness of cool head-warm body perfusion in aortic surgery. European Journal of Cardio-Thoracic Surgery. 2000;18(3):262-9.
  15. Fernandes P, Mayer R, Adams C, Chu MWA. Simultaneous individually controlled upper and lower body perfusion for valve-sparing root and total aortic arch replacement: a case study. JECT. 2011;43(4):245-51.
  16. Croughwell ND, Frasco P, Blumenthal JA, Leone BJ, White WD, Reves JG. Warming during cardiopulmonary bypass is associated with jugular bulb desaturation. Ann Thorac Surg. 1992;53(5):827-32.
  17. Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, Cleland A, Schaefer B, Irwin B, Fox S. Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesthesia & Analgesia. 2007;104(1):51-8. http://dx.doi.org/10.1213/01.ane.0000246814.29362.f4
  18. Touati G, Roux N, Carmi D, Degandt A, Benamar A, Marticho P, Nzomvuama A, Poulain HJ. Totally normothermic aortic arch replacement without circulatory arrest. Ann Thorac Surg. 2003;76(6):2115-7. http://dx.doi.org/10.1016/S0003-4975(03)00739-2