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Your search keyword '"Total aortic arch replacement surgery"' showing total 2 results
Start Over Descriptor "Total aortic arch replacement surgery" Topic aortic dissection
2 results on '"Total aortic arch replacement surgery"'

1. Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study.

Author

Lin J, Qin Z, Liu X, Xiong J, Wu Z, Guo Y, Kang D, and Du L

Subjects
Acute Disease, Adult, Aortic Dissection diagnostic imaging, Aortic Dissection mortality, Aortic Dissection physiopathology, Aorta, Thoracic diagnostic imaging, Aorta, Thoracic physiopathology, Aortic Aneurysm, Thoracic diagnostic imaging, Aortic Aneurysm, Thoracic mortality, Aortic Aneurysm, Thoracic physiopathology, Cerebrovascular Circulation, China, Female, Humans, Male, Middle Aged, Pilot Projects, Postoperative Complications mortality, Postoperative Complications therapy, Prospective Studies, Regional Blood Flow, Time Factors, Treatment Outcome, Vena Cava, Inferior diagnostic imaging, Aortic Dissection surgery, Aorta, Thoracic surgery, Aortic Aneurysm, Thoracic surgery, Blood Vessel Prosthesis Implantation adverse effects, Blood Vessel Prosthesis Implantation mortality, Perfusion adverse effects, Perfusion mortality, Vena Cava, Inferior physiopathology
Abstract

Objectives: Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes., Methods: This pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products., Results: A total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21-1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10-0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group., Conclusions: RIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications., Trial Registration: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786 .

Published
2021
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2. Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Author

Zhong Wu, Jiyue Xiong, Deying Kang, Yingqiang Guo, Jing Lin, Lei Du, Xinhao Liu, and Zhen Qin

Subjects
Adult, Male, medicine.medical_specialty, China, Blood transfusion, Time Factors, medicine.medical_treatment, Aorta, Thoracic, Pilot Projects, Vena Cava, Inferior, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, Blood Vessel Prosthesis Implantation, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Antegrade cerebral perfusion, medicine, Intubation, Diseases of the circulatory (Cardiovascular) system, Humans, Prospective Studies, Cerebral perfusion pressure, Retrograde inferior vena caval perfusion, Angiology, Aortic dissection, Aortic Aneurysm, Thoracic, business.industry, Middle Aged, medicine.disease, Surgery, Cardiac surgery, Perfusion, Aortic Dissection, Treatment Outcome, 030228 respiratory system, Regional Blood Flow, RC666-701, Cerebrovascular Circulation, Acute Disease, Total aortic arch replacement surgery, Female, Cardiology and Cardiovascular Medicine, business, Paraplegia, Research Article
Abstract

ObjectivesAntegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes.MethodsThis pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products.ResultsA total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21–1.62;p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10–0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h,p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units,p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group.ConclusionsRIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications.Trial registration: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018—Retrospectively registered,https://clinicaltrials.gov/ct2/show/NCT03607786.

Published
2021

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