European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Apr 2009
Analysis of collateral blood flow to the lower body during selective cerebral perfusion: is three-vessel perfusion better than two-vessel perfusion?
During selective cerebral perfusion (SCP), only the upper body is perfused. However, blood actually returns into the descending aorta through collaterals during SCP. This collateral blood flow (CBF) is thought to be important to protect the visceral organs and spinal cord from ischemia. The left subclavian artery is postulated to be important as a collateral source to the lower body. Therefore, we measured CBF and examined whether a perfusion technique (three- or two-vessel perfusion) affects CBF to the lower body during SCP. ⋯ Visceral organs were perfused to some extent through collaterals and protected from ischemia during SCP. Left subclavian arterial perfusion enabled significant CBF to the lower body. Considering this CBF, three-vessel perfusion appears to be better than two-vessel perfusion during SCP; however, the choice of perfusion technique may not be so important under conditions of hypothermia because the difference in CBF between the two methods was small.
-
Eur J Cardiothorac Surg · Apr 2009
Treatment of complex disease of the thoracic aorta: the frozen elephant trunk technique with the E-vita open prosthesis.
The treatment of complex aortic pathologies of the thoracic aorta remains a challenging issue in aortic surgery. The most recent development of the classic elephant trunk technique, the 'frozen elephant trunk' technique, represents the combination of an endovascular approach with a conventional surgical treatment for a hybrid approach. ⋯ The frozen elephant trunk technique with the new E-vita open prosthesis combines surgical and interventional technologies and represents a feasible and efficient option in the treatment of complex aortic pathologies. Strict monitoring of the patient has to be carried out in order to detect possible evolution of the aortic lesion, which can require prompt treatment. However, long-term follow-up is required.
-
Eur J Cardiothorac Surg · Apr 2009
Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt.
Despite the recognition of importance to avoid visceral ischemia during thoracoabdominal aortic aneurysm (TAAA) repair, the methodology of visceral perfusion seems still controversial and its pathophysiology has not been clearly understood. We investigated hepatosplanchnic metabolism during visceral perfusion/shunt in TAAA repair. ⋯ Visceral perfusion/shunt in TAAA repair may avoid critical irreversible hepatosplanchnic ischemia but provide unphysiological blood flow to the liver and thus should be shortened.
-
Eur J Cardiothorac Surg · Apr 2009
The effect of hypothermia on neuronal viability following cardiopulmonary bypass and circulatory arrest in newborn piglets.
To determine the effect of recovery with mild hypothermia after cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) on the activity of selected key proteins involved in initiation (Bax, Caspase-3) or inhibition of apoptotic injury (Bcl-2, increased ratio Bcl-2/Bax) in the brain of newborn piglets. ⋯ In neonatal piglet model of cardiopulmonary bypass with circulatory arrest, mild hypothermia during post bypass recovery provides significant protection from cellular apoptosis, as indicated by lower expression of Bax and Caspase-3 and an increased Bcl-2/Bax ratio. The biggest protection was observed in striatum probably by decreasing of neurotoxicity of striatal dopamine.