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Although the treatment in aortic surgery centers of carefully selected patients with thoracic and thoracoabdominal aortic aneurysms by surgical and endovascular techniques yields acceptable results, the fact remains that the majority of patients with extensive aneurysms are too frail for surgical resection, and cannot be treated by endovascular techniques because of the inability to revascularize...
Protection of the brain during aortic arch surgery has been— and continues to be— the primary consideration in carrying out these complex operations. Cerebral damage occurs primarily due to two mechanisms: global injury secondary to inadequate protection of the brain during interruptions of normal cerebral perfusion, and focal defects resulting from embolization of atheroma and surgical debris into...
While performing aortic arch surgery, it is mandatory to rely on a safe neuroprotective strategy to avoid cerebral damage, the most dreadful complication after repair of the arch. This can only be achieved by a combination of different modalities. Moderate (25 degrees Celsius rectal temperature) to deep (18 degrees Celsius or lower rectal temperature) cooling of the body during extracorporeal...
Summary It is critical to select the appropriate strategy for protecting the brain from ischemic and embolic injury during arch operation. Our current strategy for protecting the brain from ischemic injury is that antegrade selective cerebral perfusion (SCP) is the method of choice if cerebral protection time to be required exceeds 30 minutes. Moderately hypothermic two-vessel (innominate artery...
Having an experimental finding that intermittent pressure augmented RCP (IPA-RCP) significantly reduced postoperative brain damage in a canine model, we utilize IPA-RCP in clinical settings. IPA-RCP requires intermittent augmentation of superior vena caval pressure up to 45 mmHg every thirty seconds, while conventional RCP (C-RCP) continuous pressure of 15 mmHg. We examined the impact of IPA-RCP on...
Summary Patients and methods: From 1998 to 2007, there were 90 consecutive patients who underwent the modified arch first technique for total arch replacement using hypothermic circulatory arrest (HCA) and retrograde cerebral perfusion (RCP). There were 63 true aneurysms, and 13 chronic and 11 acute Stanford type A dissections. Sixteen cases were operated on as emergencies. Results...
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