[The strategy to avoid malperfusion of vital organs during operation for acute aortic dissection; multi-monitoring and right brachial artery perfusion].
BACKGROUND
Malperfusion of vital organs is the most serious complication during cardiopulmonary bypass for acute aortic dissection.


METHODS
From 2001 to 2006, 40 patients underwent operation for acute type A aortic dissection. Right brachial artery perfusion was performed in 20 patients. From May 2005, transesophageal echocardiography and cerebral oxygenation measured by near infrared spectroscopy were continuously monitored during operation.


RESULTS
There were 3 in-hospital deaths and 3 brain infarction. Switching of blood flow during cardiopulmonary bypass occurred in 3 patients; 2 patients suffered from diffuse brain infarction while. in the other patient, switching of perfusion was detected at once by multi-monitoring and resolved by induction of right brachial artery perfusion.


CONCLUSIONS
Close monitoring of cerebral oxygenation by near infrared spectroscopy, transesophageal echocardiography and right brachial artery perfusion are effective in operation for acute aortic dissection.
Miyairi
Takeshi
T
Department of Cardiovascular Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
Kigawa
I
I
Miura
Y
Y
Shimada
S
S
Fukuda
S
S
Wanibuchi
Y
Y
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D001916:Brachial Artery; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010477:Perfusion; D019265:Spectroscopy, Near-Infrared