title: Unilateral Antegrade Cerebral Perfusion and Moderate Hypothermia: Assessing Safety With Novel Biomarkers.
abstract: BACKGROUND
  Antegrade cerebral perfusion in aortic surgery is a well-established brain protection method. Open distal anastomosis during aortic surgery has some well-known advantages. Antegrade cerebral perfusion allows repair to some extent of the aortic arch, even in isolated ascending aortic aneurysm. The present study aims to investigate the adequacy of contralateral perfusion with novel oxidative stress parameters during unilateral antegrade cerebral perfusion.
  
  
  METHODS
  The study included 30 consecutive patients undergoing thoracic aortic surgery with unilateral antegrade cerebral perfusion (uACP) under moderate hypothermia (28° C). Blood samples from right and left jugular vein were obtained at four time intervals during surgery (after the anaesthetic induction - Phase 1, at the beginning of cardiopulmonary bypass - Phase 2, 15thminute of uACP - Phase 3 and after weaning from cardiopulmonary bypass - Phase 4). Novel oxidative stress parameters (advanced oxidation protein products, sialic acid, thiol reagents and ischaemia-modified serum albumin), blood gas analysis, and serum glucose and lactate levels were measured. In addition, intraoperative and early postoperative follow-up parameters were recorded.
  
  
  RESULTS
  Mean unilateral antegrade cerebral perfusion time was observed to be 16.4±5.9min (9 - 46min). No significant differences between right and left hemispheres were observed in novel oxidative parameters or biochemical values. There was only one temporary neurological deficit (3.3%) in the patient group.
  
  
  CONCLUSIONS
  The present study demonstrated that open distal anastomosis for hemiarch repair can be performed safely with unilateral antegrade cerebral perfusion under moderate hypothermia with both clinical outcome and novel biomarkers.
authors: Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors: Bahadır
authors: B
authors: Aytekin
authors: Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey. Electronic address: utkuunal@gmail.com.
authors: Ertekin Utku
authors: EU
authors: Ünal
authors: Department of Anesthesiology and Reanimation, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors: Aslı
authors: A
authors: Demir
authors: Department of Biology, Science Faculty, Istanbul University, Istanbul, Turkey.
authors: Uğur
authors: U
authors: Aksu
authors: Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors: Aytaç
authors: A
authors: Çalışkan
authors: Department of Biology, Science Faculty, Istanbul University, Istanbul, Turkey.
authors: Kübra
authors: K
authors: Vardar
authors: Department of Anesthesiology and Reanimation, University of Acıbadem, Istanbul, Turkey.
authors: Fevzi
authors: F
authors: Toraman
authors: Department of Cardiovascular Surgery, Turkey Yuksek Ihtisas Training and Research Hospital, Ankara, Turkey.
authors: Ahmet
authors: A
authors: Sarıtaş
mesh_terms: D062107:Advanced Oxidation Protein Products / Q000097:blood*; D000368:Aged; D001011:Aorta / Q000601:surgery; D001019:Aortic Rupture / Q000097:blood / Q000601:surgery; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002560:Cerebrovascular Circulation; D006801:Humans; D007036:Hypothermia, Induced; D019344:Lactic Acid / Q000097:blood*; D008875:Middle Aged; D019158:N-Acetylneuraminic Acid / Q000097:blood*; D012449:Safety; D012709:Serum Albumin / Q000378:metabolism*
chemical_list: D062107:Advanced Oxidation Protein Products; D015415:Biomarkers; D001786:Blood Glucose; D012709:Serum Albumin; D019344:Lactic Acid; D019158:N-Acetylneuraminic Acid
keywords: Advanced oxidation protein products; Antegrade cerebral perfusion; Ischaemia-modified serum albumin; Oxidative stress; Sialic acid; Thiol reagents