title: Deep Hypothermic Circulatory Arrest vs. Antegrade Cerebral Perfusion in Cerebral Protection during the Surgical Treatment of Chronic Dissection of the Ascending and Arch Aorta.
abstract: Circulatory arrest during aortic surgery presents a risk of neurological complications. The present study aimed to investigate the effectiveness of deep hypothermic circulatory arrest (DHCA) vs. antegrade cerebral perfusion (ACP) in cerebral protection during the surgical treatment of chronic dissection of the ascending and arch aorta and to assess the quality-of-life (QoL) in the long-term postoperative period with respect to the used cerebral protection method. In a prospective, randomized study, 58 patients with chronic type I aortic dissection who underwent ascending aorta and aortic arch replacement surgery were included. Patients were allocated in two groups: 29 patients who underwent surgery under moderate hypothermia (24°C) combined with ACP and 29 patients who underwent surgery under DHCA (18°C) with craniocerebral hypothermia. The regional hemoglobin oxygen saturation (rSO2, %) were compared during surgery, neurological complications were analyzed during the early postoperative period, QoL was compared in the long-term postoperative period (1-year follow-up). During the early postoperative period, 37.9% of patients in the DHCA group exhibited neurological complications, compared with 13.8% of those in the ACP group (p< .05). The risk of neurological complications in the early postoperative period was dependent on the extent of rSO2decrease during circulatory arrest. In the ACP group, rSO2decreased by ≤17% from baseline during circulatory arrest. In the DHCA group, a more profound decrease in rSO2(>30%) was recorded (p< .05). QoL in the long-term period after surgery improved, but it was not dependent on the cerebral protection method used during surgery. ACP during aortic replacement demonstrated the most advanced properties of cerebral protection that can be evidenced by a lesser degree of neurological complications, compared with patients who underwent surgery under conditions of DHCA. QoL after surgery was not dependent on the cerebral protection method used during surgery.
authors.affiliation: Clinical Physiology Group, Center of Anesthesiology and Critical Care Medicine, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, 630055, Russia.
authors.forename: Oksana Vasilyevna
authors.initials: OV
authors.lastname: Kamenskaya
authors.affiliation: Clinical Physiology Group, Center of Anesthesiology and Critical Care Medicine, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, 630055, Russia.
authors.forename: Asya Stanislavovna
authors.initials: AS
authors.lastname: Klinkova
authors.affiliation: Center of Surgery, Aorta, Coronary and Peripheral Arteries, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, 630055, Russia.
authors.forename: Alexander Mikhailovich
authors.initials: AM
authors.lastname: Chernyavsky
authors.affiliation: Center of Anesthesiology and Critical Care Medicine, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, 630055, Russia.
authors.forename: Vladimir Vladimirovich
authors.initials: VV
authors.lastname: Lomivorotov
authors.affiliation: Clinical Physiology Group, Center of Anesthesiology and Critical Care Medicine, Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, 630055, Russia.
authors.forename: Ivan Olegovich
authors.initials: IO
authors.lastname: Meshkov
authors.affiliation: Novosibirsk Research Institute of Circulation Pathology, Novosibirsk, 630055, Russia.
authors.forename: Alexander Mikhailovich
authors.initials: AM
authors.lastname: Karaskov
mesh_terms: D000328:Adult; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology* / Q000517:prevention & control*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*
keywords: aortic prosthesis; cerebral oxygenation; cerebral protection; neurologic injury