POSTER PRESENTATION Aortic Live 2 Essen Germany, 11/13.09.2014

1. Perfusion strategies in acute type A aortic
dissection: single center experience
Azienda Ospedaliera SS Antonio e
Biagio Alessandria, ITALY
C.Cavozza, A. Audo, A.Campanella , P.
Scoti, M.Serra, G. Camporini ,
D. Mercogliano
SOC Cardiac Surgery
Mortality and morbidity in the setting of acute type
A aortic dissection were most correlated with
surgical techniques and strategies of tissues and
organs protection
MORTALITY 18%
CAUSES OF DEATH
•Low cai-organrdiac output
•Stroke
•Mult-failure
•intraoperativeDescending aortic
rupture
Site of arterial cannulation:
After Sternotomy: if no dissected innominate artery (direct) or subclavian artery
below sterno-clavicular junction (dacron graft) or axillary artery (dacron graft )
Method
91 patients with a mean age of 62.6 ± 14.8 years underwent surgery for Stanford
type A dissection. After sternotomy, arterial cannulation is direct into innominate
artery, while is made through a dacron graft into the right subclavian or axillary
artery. Antegrade selective cerebral perfusion has been used as during hypothermic
circulatory arrest. To assess unilateral or bilateral brain perfusion we used near-infrared
spectroscopy.
In last ten patients a cuffed cannula , connected to separate roller pump, was
inserted into the descending thoracic aorta. Perfusion in the distal body, as well
selective antegrade brain perfusion, were started simultaneously
Results
Mean duration of CPB and aortic cross-clamping was 183±82 and 104±27min,
respectively. The mean duration of circulatory arrest and brain perfusion was
38,6±15 min. Ascending aorta with aortic valve resunspension and hemi-arch
replacement was the most frequent surgical procedure. Twelve patients underwent
bilateral perfusion because of unilateral drop less than 20% of the baseline value of
NIRS. Overall mortality was 18,6%.
Selective Antegrade Cerebral Perfusion
(SACP) has probably become the gold
standard for cerebral protection during
aortic surgery.
Some technical aspects related to the
management of SACP remain controversial
: Site of arterial cannulation, degree of
hypothermia, exstension (bilateral,
unilateral)
Brain perfusion during HCA
• To asses brain perfusion we used infrared
spectroscopy scalp capillary saturation by a dual
sensor for NIRS
• NIRS: rSO 2 regional SO2 left reduction of 20%
from baseline values or an absolute decrease of
50%
Bilateral Cerebral Perfusion is mandatory
Data Preoperative state
Low Body Perfusion:
ten patients.
Pruitt catheter (PRUITT® -
LeMaitre Vascular)
connected to cardioplegia
line 0,6-0,8 l/m
Monitoring NIRS :
lower back and brain
Preliminary results
Pre and postoperative measuraments of renal and
hepatic function
STERNOTOMY
CENTRAL CANNULATION
CPB ON HYPOTHERMIA 26°C
Operative Techniques
Replacement of ascending aorta 100%
Replacement of Transverse Arch 21%
Replacement of Aortic Valve
-Isolated
-Composite Graft
18%
20%
Rewarming time more fast
In this group no patient had permanent neurologic deficit
Conclusions
The central cannulation offers the advantage of antegrade perfusion of the aorta. In addition,
performing low body perfusion at the same time will enable safe increase in the systemic temperature during CPB and reduce morbidity and
mortality