Friess, Jan-Oliver; Beeler, Maurus; Yildiz, Murat; Guensch, Dominik; Levis, Anja; Gerber, Daniel; Wollborn, Jakob; Jenni, Hansjoerg; Huber, Markus; Schönhoff, Florian; Erdoes, Gabor (2023). Determination of selective antegrade perfusion flow rate in aortic arch surgery to restore baseline cerebral near-infrared spectroscopy values: a single centre observational study. European journal of cardio-thoracic surgery, 63(4) Oxford University Press 10.1093/ejcts/ezad047
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OBJECTIVE
Neuroprotection during aortic arch surgery involves selective antegrade cerebral perfusion. The parameters of cerebral perfusion, e.g. flow rate, are inconsistent across centers and are subject of debate. The aim of this study was to determine the cerebral perfusion flow rate during hypothermic circulatory arrest required to meet preoperative awake baseline regional cerebral oxygen saturation (rSO2).
METHODS
Patients scheduled for aortic arch surgery with hypothermic circulatory arrest were enrolled in this prospective observational study. After initiation of hypothermic circulatory arrest, bilateral selective antegrade cerebral perfusion was established and cerebral flow rate was continuously increased. The primary endpoint was the difference of cerebral saturation from baseline during cerebral perfusion flow rates of 6 ml/kg/min, 8 ml/kg/min, and 10 ml/kg/min.
RESULTS
A total of 40 patients were included. During antegrade cerebral perfusion rSO2 was significantly lower than the baseline at 6ml/kg/min (-7.3, 95%-CI: -1.7,-12.9; p=0.0015). In contrast flow rates of 8 and 10 ml/kg/min resulted in rSO2 that did not significantly differ from the baseline (-2; 95%-CI: -4.3,8.3; p>0.99 and 1.8; (95%-CI: -8.5%, 4.8%; p>0.99). Cerebral saturation was significantly more likely to meet baseline values during selective antegrade cerebral perfusion with 8ml/kg/min than at 6ml/kg/min (44.1%; 95%-CI: 27.4%,60.8% vs 11.8%; 95% CI: 0.9%,22.6%; p = 0.0001).
CONCLUSION
At 8 ml/kg/min cerebral flow rate during selective antegrade cerebral perfusion regional cerebral oximetry baseline values are significantly more likely to be achieved than at 6 ml/kg/min. Further increasing the cerebral flow rate to 10 ml/kg/min does not significantly improve rSO2.
CLINICALTRIALS.GOV IDENTIFIER
NCT03484104.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy 04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy > Partial clinic Insel 04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Heart Surgery |
UniBE Contributor: |
Friess, Jan-Oliver, Yildiz, Murat, Günsch, Dominik, Levis, Anja, Gerber, Daniel, Jenni, Hansjoerg, Huber, Markus, Erdoes, Gabor (B) |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
1873-734X |
Publisher: |
Oxford University Press |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
13 Feb 2023 10:12 |
Last Modified: |
27 Feb 2024 14:27 |
Publisher DOI: |
10.1093/ejcts/ezad047 |
PubMed ID: |
36762841 |
BORIS DOI: |
10.48350/178622 |
URI: |
https://boris.unibe.ch/id/eprint/178622 |
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