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Electroencephalography During Hemiarch Replacement With Moderate Hypothermic Circulatory Arrest
Jeffrey E Keenan1, Hanghang Wang1, Asvin M Ganapathi1
1Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina.
The Annals of Thoracic Surgery
|October 21, 2015
Summary
Intraoperative electroencephalography (EEG) monitoring during moderate hypothermic circulatory arrest (MHCA) with selective antegrade cerebral perfusion (SACP) revealed that nearly half of patients experienced loss of brain activity after circulatory arrest. Unilateral SACP typically restored activity, but EEG can identify persistent cerebral ischemia.
Area of Science:
- Neuroscience
- Cardiovascular Surgery
- Anesthesiology
Background:
- Intraoperative electroencephalography (EEG) during moderate hypothermic circulatory arrest (MHCA) with selective antegrade cerebral perfusion (SACP) is not well-described.
- Characterizing EEG patterns during this procedure is crucial for understanding cerebral activity and potential ischemia.
Purpose of the Study:
- To characterize intraoperative electroencephalography (EEG) patterns during MHCA with SACP.
- To identify the incidence and implications of electrocerebral activity changes during this surgical procedure.
Main Methods:
- Retrospective study of 71 patients undergoing aortic hemiarch replacement with MHCA (<28°C) and unilateral SACP.
- EEG monitoring before, immediately after, and after SACP establishment.
- Comparison of patient characteristics and outcomes based on EEG changes.
Main Results:
- Before circulatory arrest (CA), 66% had continuous EEG and 34% had burst suppression.
- Immediately after CA, 45% showed abrupt loss of electrocerebral activity, indicating potential cerebral ischemia.
- Unilateral SACP restored activity in most patients, but EEG identified 2 cases of persistent ischemia.
Conclusions:
- Nearly half of patients undergoing MHCA/SACP experience loss of electrocerebral activity post-CA.
- Intraoperative EEG is valuable for identifying persistent cerebral ischemia despite SACP.
- EEG monitoring can guide management in complex aortic surgeries.
