Metabolic relevance during isolation technique in total arch repair for patients at high risk with embolic stroke.

Abstract:

:In patients undergoing total arch replacement with protruding or mobile atheroma in the proximal aorta, we isolate cerebral circulation from systemic one by starting selective cerebral perfusion (SCP) before systemic arterial perfusion to prevent aortogenic embolic stroke. We disclose the safety of this isolation technique by measuring cerebral oxygenation and metabolism. Sixty-six patients underwent total arch replacement using SCP since 1998. The isolation technique was applied in sixteen patients. Jugular venous oxygen saturation (SjO(2)) was monitored in nine patients undergoing isolation technique (isolation-group) and in thirteen patients of the rest (conventional-group). Oxygen, glucose, and lactate extraction ratio (OER, GER, and LER) were measured at seven time points peri-operatively. The isolation-group had significantly longer SCP time (isolation: 185+/-52 min vs. conventional: 140+/-43 min, P<0.01). During cooling, SjO(2) was kept comparable between groups. OER was minimum at the end of cooling and comparable between groups (isolation: 3.8+/-7.7% vs. conventional: 11.7+/-13.8%, P=0.37). There were no significant differences in GER and LER between groups. There were neither in-hospital death nor stroke. Temporary neurological dysfunction was observed only in conventional-group (n=3, 23%, P=0.12). Isolation technique for total arch replacement could be performed safely and may provide acceptable results in patients at high risk for embolic stroke.

authors

Kunihara T,Shiiya N,Matsuzaki K,Matsui Y

doi

10.1510/icvts.2007.164137

subject

Has Abstract

pub_date

2008-02-01 00:00:00

pages

58-62

issue

1

eissn

1569-9293

issn

1569-9285

pii

icvts.2007.164137

journal_volume

7

pub_type

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