Review
Anesthesiology
Samit Ghia, Andre Savadjian, Dawi Shin, Gabriele Diluozzo, Menachem M. Weiner, Himani Bhatt
Summary: Diseases affecting the aortic arch often require surgical intervention. Hypothermic circulatory arrest (HCA) is a safe approach for open aortic arch surgeries, providing neuroprotection by reducing cerebral metabolism and oxygen requirements. However, HCA comes with significant risks, such as neurologic dysfunction, stroke, and coagulopathy, requiring the cardiac anesthesiologist to have a complete understanding of surgical techniques, possible complications, and management strategies.
JOURNAL OF CARDIOTHORACIC AND VASCULAR ANESTHESIA
(2023)
Article
Medicine, General & Internal
Kevin Pilarczyk, Bernd Panholzer, Katharina Huenges, Mohamed Salem, Toni Jacob, Jochen Cremer, Assad Haneya
Summary: This study investigates the role of new biomarkers in predicting acute kidney injury (AKI) after thoracic aortic surgery (TAS) with moderate hypothermic circulatory arrest (MHCA). The results show that Cystatin C is a highly sensitive and specific biomarker for predicting AKI even before surgery, while the predictive capacity of [TIMP-2]*[IGFBP7] is only moderate and inferior to that of serum creatinine.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Xinliang Guan, Lei Li, Xuran Lu, Ming Gong, Haiyang Li, Yuyong Liu, Wenjian Jiang, Feng Lan, Xiaolong Wang, Hongjia Zhang
Summary: The aim of this study was to investigate the safety and efficacy of fibrinogen concentrate in patients with acute type A aortic dissection. The results showed that fibrinogen concentrate effectively increased the plasma fibrinogen level and significantly reduced the volumes of transfused allogeneic blood products and blood loss in patients with aortic arch surgery. There were no serious adverse events in the patients who received fibrinogen concentrate treatment.
JOURNAL OF THROMBOSIS AND THROMBOLYSIS
(2023)
Article
Cardiac & Cardiovascular Systems
Diane Hu, David Blitzer, Yanling Zhao, Christine Chan, Tsuyoshi Yamabe, Ilya Kim, Adedeji Adeniyi, Christian Pearsall, Paul Kurlansky, Isaac George, Craig R. Smith, Virendra Patel, Hiroo Takayama
Summary: This study aimed to investigate the association between parameters surrounding circulatory arrest and postoperative acute kidney injury in aortic surgery. The results showed that the duration of lower-body ischemia was not independently associated with acute kidney injury, while hypertension, preoperative estimated glomerular filtration rate, packed red blood cell transfusion volume, and nadir temperature were independently associated. The study suggests considering these factors in aortic repair surgeries to prevent acute kidney injury.
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
(2023)
Article
Cardiac & Cardiovascular Systems
Andrew M. Vekstein, Babtunde A. Yerokun, Oliver K. Jawitz, Julie W. Doberne, Jatin Anand, Jorn Karhausen, David N. Ranney, Ehsan Benrashid, Hanghang Wang, Jeffrey E. Keenan, Jacob N. Schroder, Jeffrey G. Gaca, G. Chad Hughes
Summary: The study found that in patients undergoing proximal aortic surgery and requiring HCA, the degree of systemic hypothermia was not associated with the risk of AKI.
EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY
(2021)
Article
Cardiac & Cardiovascular Systems
Hiroshi Sato, Nobuyoshi Kawaharada, Joji Fukada, Keitaro Nakanishi, Takuma Mikami, Tsuyoshi Shibata, Ryo Harada, Syuichi Naraoka, Takeshi Kamada, Yukihiko Tamiya
Summary: A study established an estimation model for hypothermic circulatory arrest time and analyzed risk factors for major adverse outcomes in total arch replacement surgery. Results identified atrial fibrillation, rupture, malperfusion, saccular aneurysm, cardiopulmonary bypass time, and hypothermic circulatory arrest time as independent risk factors. The predicted hypothermic circulatory arrest time using the model detected significant factors associated with major adverse outcomes.
ANNALS OF THORACIC SURGERY
(2022)
Article
Cardiac & Cardiovascular Systems
Varun J. Sharma, Abbie R. Kanagarajah, Siven Seevanayagam, Michelle Kim, George Matalanis
Summary: This report describes a branch-first continuous perfusion aortic arch replacement (BF-CPAR) technique and presents the midterm results. By performing branch reconstruction before circulatory arrest, this technique overcomes the higher mortality and morbidity associated with aortic arch surgery. Results demonstrate excellent 10-year outcomes for both elective and emergency cases.
ANNALS OF THORACIC SURGERY
(2023)
Article
Cardiac & Cardiovascular Systems
Yanxiang Liu, Bowen Zhang, Shenghua Liang, Yaojun Dun, Hongwei Guo, Xiangyang Qian, Cuntao Yu, Xiaogang Sun
Summary: The study evaluated the short and mid-term outcomes of type II hybrid arch repair (HAR) in the management of aortic arch diseases. The results showed satisfactory early and mid-term outcomes of this surgical option in complex aortic arch pathologies.
FRONTIERS IN CARDIOVASCULAR MEDICINE
(2022)
Article
Cardiac & Cardiovascular Systems
Jennifer Chung, Louis-Mathieu Stevens, Michael W. A. Chu, Francois Dagenais, Mark D. Peterson, Munir Boodhwani, John Bozinovski, Ismail El-Hamamsy, Michael H. Yamashita, Rony Atoui, Bindu Bittira, Darrin Payne, Maral Ouzounian
Summary: The study found that older patients have higher rates of complications and mortality after aortic arch surgery, supporting a more cautious approach when evaluating elderly patients. Further research is needed on the age-related natural history of thoracic aneurysms and size thresholds for intervention.
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
(2021)
Article
Pharmacology & Pharmacy
Weidong Yan, Sizhe Gao, Qiaoni Zhang, Jiachen Qi, Gang Liu, Yuan Teng, Jian Wang, Shujie Yan, Bingyang Ji
Summary: This study found that administration of AdipoRon, a small-molecule adiponectin receptor agonist, could inhibit neuroinflammation following DHCA by improving vital signs, attenuating proinflammatory cytokines, inhibiting microglial activation, and promoting their transition to an anti-inflammatory state through the AMPK/NF-kappa B pathway.
Review
Cardiac & Cardiovascular Systems
Sven Z. Tan, Sidhant Singh, Natasha J. Austin, Joaquin Alfonso Palanca, Matti Jubouri, Leonard N. Girardi, Edward P. Chen, Mohamad Bashir
Summary: This review analyzed the relationship between DHCA duration and clinical outcome, and evaluated the controversies and limitations surrounding its use. Statistical analysis revealed no significant association between DHCA duration and clinical outcomes. Alternative surgical and endovascular techniques, as well as the use of biomarkers for early diagnosis and intervention, have been identified as promising future directions.
JOURNAL OF CARDIOVASCULAR SURGERY
(2022)
Article
Surgery
Yinejie Du, Zhongrong Fang, Yanhua Sun, Congya Zhang, Guiyu Lei, Yimeng Chen, Lijing Yang, Xiying Yang, Jun Li, Guyan Wang
Summary: This study compared the incidence of severe systemic inflammatory response syndrome (sSIRS) after total aortic arch replacement between patients who underwent moderate hypothermic circulatory arrest (MHCA) and those who underwent deep hypothermic circulatory arrest (DHCA). The results showed that the incidence of sSIRS was similar between the two groups, but patients in the DHCA group had higher rates of gastrointestinal hemorrhage and pulmonary infection, and longer post-operative length of stay.
FRONTIERS IN SURGERY
(2021)
Article
Cardiac & Cardiovascular Systems
Mahmoud Alhussaini, Matheus P. Falasa, Eric I. Jeng, Tomas Martin, Torben K. Becker, George J. Arnaoutakis, Amber Fillion, Dan Neal, Thomas M. Beaver
Summary: DHCA can be used for combined repair of aortic arch and descending thoracic aortic aneurysm via left thoracotomy without significant increase in major adverse outcomes compared to non-DHCA group.
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
(2023)
Article
Medicine, General & Internal
Mona Salehi Ravesh, Christine Friedrich, Jan Schoettler, Lars Hummitzsch, Gunnar Elke, Mohamed Salem, Georg Lutter, Thomas Puehler, Jochen Cremer, Assad Haneya
Summary: Our study results demonstrate that improvements in perioperative management, including antegrade cerebral perfusion, enable the successful surgical treatment of AAAD even with a DHCA duration longer than 60 minutes.
JOURNAL OF CLINICAL MEDICINE
(2022)
Article
Cell Biology
Qiang Chen, Yu-Qing Lei, Jian-Feng Liu, Zeng-Chun Wang, Hua Cao
Summary: This study found that TPL improved neurobehavioral functions, reduced neuroinflammation and oxidative stress, and inhibited microglial activation and cell death in DHCA rats. Additionally, TPL activated the Nrf2 pathway and suppressed NF-kappa B activity, suggesting potential mechanisms for its neuroprotective effects.