Prolonged Periods of Antegrade Cerebral Perfusion Are Safe During Elective Arch Surgery

医学 循环系统 脑灌注压 麻醉 主动脉弓 冲程(发动机) 灌注 外科 主动脉 心脏病学 机械工程 工程类
作者
W. Brent Keeling,David H. Tian,Woodrow J. Farrington,Riccardo Sinatra,Alessandro Della Corte,Roberto Chiesa,J. Malcolm Underwood,Bradley G. Leshnower,Edward P. Chen
出处
期刊:The Annals of Thoracic Surgery [Elsevier]
卷期号:115 (2): 387-394 被引量:2
标识
DOI:10.1016/j.athoracsur.2022.05.038
摘要

Cerebral circulatory arrest times >40 minutes during aortic surgery have previously been shown to be associated with increased morbidity and mortality. The purpose of this study was to redefine what would constitute a safe period of circulatory arrest for patients who underwent elective proximal aortic operations requiring antegrade cerebral perfusion (ACP).The ARCH International aortic database was queried, and 2008 patients undergoing elective arch operations with circulatory arrest using ACP were identified. Circulatory arrest time was categorized a priori in 10-minute intervals. To further determine the impact of this variable on outcomes, hierarchical multivariable regression analysis was performed.Unadjusted mortality increased with increasing circulatory arrest time from 4.8% (<40 minutes) to 13.5% (>90 minutes; P < .001), but risk of stroke was not impacted (P = .4). When treated as a continuous variable, mortality increased significantly with increasing circulatory arrest time, whereas the risk of permanent stroke did not. Using <40 minutes as the reference, multivariable analysis showed no statistical increase in mortality for ranges up to 80 minutes of circulatory arrest. The risk of permanent stroke was not significantly higher for any time interval >40 minutes up to 90 minutes.In this series of patients who underwent elective proximal aortic surgery using ACP, periods of circulatory arrest up to at least 80 minutes were not associated with significant increases in mortality or permanent stroke. Modern perfusion strategies have allowed for increased safety during elective arch cases requiring prolonged periods of circulatory arrest.
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