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[Problems of brain protection in aortic arch operations]
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk
|May 25, 2005
Summary
This study on aortic arch surgery found that antegrade cerebral perfusion was the most common brain protection method. While hospital mortality was 18.1%, severe neurological complications were avoided.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Aortic arch replacement is a complex procedure requiring robust brain protection strategies.
- Various methods exist to safeguard the brain during circulatory arrest, each with potential benefits and risks.
Purpose of the Study:
- To evaluate the effectiveness of different brain protection methods during ascending aorta and aortic arch replacement.
- To assess the neurological outcomes and hospital mortality associated with these surgical interventions.
Main Methods:
- Retrospective analysis of 33 patients undergoing ascending aorta and aortic arch replacement.
- Comparison of brain protection techniques: profound hypothermic circulatory arrest, retrograde brain perfusion, and antegrade cerebral perfusion.
- Inclusion of pharmacological brain protection as an adjunct in all cases.
Main Results:
- Antegrade cerebral perfusion via brachycephalic vessels was used in 54.6% of patients, the most frequent method.
- Hospital mortality rate was 18.1% (6 patients).
- Transient neurological dysfunction occurred in 24% of patients; no cerebral strokes or intractable neurological disorders were reported.
Conclusions:
- The selection of brain protection strategy is influenced by the scope of the aortic arch operation and the required duration of circulatory arrest.
- While significant neurological complications were not observed, the mortality rate highlights the inherent risks of these procedures.
- Antegrade cerebral perfusion appears to be a preferred method for brain protection in aortic arch surgery.