Deep Hypothermia With Retrograde Cerebral Perfusion Versus Moderate Hypothermia With Antegrade Cerebral Perfusion for Arch Surgery
Deep Hypothermia With Retrograde Cerebral Perfusion Versus Moderate Hypothermia With Antegrade Cerebral Perfusion for Arch Surgery
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DOI：
10.1016/j.athoracsur.2018.10.008
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发表时间：
2019-04-01
影响因子：
4.6
通讯作者：
Chen, Edward P.
中科院分区：
文献类型：
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作者：
Leshnower, Bradley G.;Rangaraju, Srikant;Chen, Edward P.
背景。接受主动脉弓置换术的患者发生神经损伤的风险很高。本研究比较了接受选择性横向半弓置换术的患者的两种不同的既定神经保护策略。方法。 20 名接受半弓置换术的患者被前瞻性随机分配接受深低温停循环逆行脑灌注 (DHCA+RCP) 或中度低温停循环顺行脑灌注 (MHCA+ACP)。所有患者在出院前均接受了神经科医生裁定的检查和磁共振成像。主要终点是中风、短暂性脑缺血发作和磁共振成像判定的损伤的复合终点。次要终点是短暂的神经功能障碍、美国国立卫生研究院卒中量表和神经认知评分。结果。随机化产生 11 名 DHCA+RCP 患者和 9 名 MHCA+ACP 患者。体外循环、交叉钳夹或停循环时间没有差异。 MHCA+ACP 患者在明显高于 DHCA+RCP 患者（19.9 +/- 0.1 ℃，p < 0.0001）的温度（26.3 ℃ +/- 1.8 ℃）下经历循环停止。两组均未出现死亡或肾功能衰竭。每组均有1例中风。美国国立卫生研究院卒中量表评分和神经认知测试结果相当。弥散加权磁共振成像显示 MHCA+ACP 患者的病变率为 100%（9 人中的 9 人），而 DHCA+RCP 患者的病变率为 45%（11 人中的 5 人）（p < 0.01）。 MHCA+ACP 患者的病变数量显着高于 DHCA+RCP 患者 (p < 0.01)。 MHCA+ACP 患者的主要终点为 100%，而 DHCA+RCP 患者为 45%（p < 0.01）。结论。尽管临床上明显的神经损伤没有显着差异，但这项初步研究表明，在接受选择性半弓置换术的患者中，与 DHCA+RCP 相比，MHCA+ACP 可能与更高的放射学神经损伤发生率相关。 (C) 2019 年胸外科医师协会
Background. Patients undergoing aortic arch replacement are at high risk for neurologic injury. This study compared two different established neuroprotective strategies in patients undergoing elective transverse hemiarch replacement.Methods. Twenty patients undergoing hemiarch replacement were prospectively randomized to receive deep hypothermic circulatory arrest with retrograde cerebral perfusion (DHCA+RCP) or moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA+ACP). All patients received neurologist-adjudicated examinations and magnetic resonance imaging before discharge. The primary end point was a composite of stroke, transient ischemic attack, and magnetic resonance imaging-adjudicated injury. Secondary end points were transient neurologic dysfunction, and the National Institutes of Health Stroke Scale, and neurocognitive scores.Results. Randomization resulted in 11 DHCA+RCP patients and 9 MHCA+ACP patients. There was no difference in cardiopulmonary bypass, cross-clamp, or circulatory arrest times. MHCA+ACP patients underwent circulatory arrest at significantly warmer temperatures (26.3 degrees +/- 1.8 degrees C) than DHCA+RCP patients (19.9 degrees +/- 0.1 degrees C, p < 0.0001). There were no deaths or renal failure in either group. There was 1 stroke in each group. National Institute of Health stroke scale scores and neurocognitive test results were equivalent. Diffusion-weighted magnetic resonance imaging demonstrated lesions in 100% (9 of 9) of MHCA+ACP patients compared with 45% (5 of 11) of DHCA+RCP patients (p < 0.01). MHCA+ACP patients had a significantly higher number of lesions than DHCA+RCP patients (p < 0.01). The primary end point was achieved in 100% of MHCA+ACP patients compared with 45% of DHCA+RCP patients (p < 0.01).Conclusions. Although there was no significant difference in clinically evident neurologic injury, this pilot study suggests that MHCA+ACP may be associated with a higher incidence of radiographic neurologic injury than DHCA+RCP in patients undergoing elective hemiarch replacement. (C) 2019 by The Society of Thoracic Surgeons