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SAFETY OF UNILATERAL Vs BILATERAL
CEREBRAL PERFUSION DURING AORTIC
SURGERY ASSESSED USING REGIONAL
CEREBRAL OXYGEN SATURATION
MONITORING
Totaro P
Paris M
Amoroso F
Milanesi E
Maurelli M
Vigano’ M
IRCCS “Foundation Hospital S Matteo”
Pavia
Background
Selective Antegrade Cerebral Perfusion (SACP) has probably become the
gold standard for cerebral protection during aortic surgery.
However
Some technical aspects related to the management of SACP remain
controversial .
Open Issues
Site of Arterial Cannulation
Degree of Hypothermia
Extension of SACP
Unilateral
Bilateral
P.Totaro… Safety of unilateral cerebral perfusion…
Background
ATS 2009
ATS 2010
P.Totaro… Safety of unilateral cerebral perfusion…
Objective
Objective of the present study is to evaluate the efficacy of Unilateral
Selective Antegrade Cerebral Perfusion (uSACP) compared to Bilateral
Antegrade Cerebral Perfusion (bSACP) during Aortic Surgery
Patients Population
(2006 – June 2010)
Patients
Surgical Details
60
Patients
60
Male
Female
23 (38)
37 (62)
Arterial Cannulation
Axillary
Femoral
Age at operation
65±14
Deep Hypothermia
6 (10)
BSA
1.8±0.2
Aortic Dissection
30 (50)
SACP
bSCAP (Group A)
uSCAP (Group B)
23 (38)
37 (62)
Sex
54 (90)
6 (10)
P.Totaro… Safety of unilateral cerebral perfusion…
NIRS Monitoring Background
P.Totaro… Safety of unilateral cerebral perfusion…
CONS
PRO
- Easy to manage
- Sensitive to the location
- Easy Interpretation
- No significant difference shown in
terms of action
- Cost-effective
- Reproducible
- No dedicated technician
- No correlation to neurological
impairment following CABG
- Allows for prompt action
- Still under-utilized
Key Point For NIRS Monitoring
We have to consider the trend of rCSo for any single patient and not
the absolute value compared between different patients
P.Totaro… Safety of unilateral cerebral perfusion…
NIRS Advanced Analysis
MOCS
CROCS
LOCS
MDDCA
Overall Mean Oxygen Cerebral Saturation
Cumulative Reduction of Regional Oxygen Cerebral
Saturation >25 %
Lowest Oxygen Cerebral Saturation
Maximum Drop of Regional Oxygen Cerebral
Saturation During Circulatory Arrest
P.Totaro… Safety of unilateral cerebral perfusion…
Results
Groups were homogeneous for preoperative characteristics
Parameter
Group A
bSACP
Group B
uSACP
23
37
Male
Female
14 (60)
9 (40)
26 (70)
11 (30)
0,3
Age at operation
66±17
66±13
0,6
Acute Dissection
13 (56)
17 (45)
0,12
1.77±0.23
1.85±0.22
0,16
Patients
p
Sex
BSA
Surgical Parameters
ECC Time
249±91
193±70
0,02
Aortic Cross Clamp
119±52
86±38
0,02
Hypothermia
Deep
Moderate
12 (55)
11 (45)
6 (16)
31 (84)
0,037
Lower NF Temperature (°)
22±4
25±2
0,001
Circulatory Arrest Time
53±32
40±31
0,18
P.Totaro… Safety of unilateral cerebral perfusion…
Results
Near Infra-Red Spectroscopy
MOCS
Overall Mean Oxygen Cerebral Saturation
Baseline
%
%
P.Totaro… Safety of unilateral cerebral perfusion…
MDDCA
LOCS
Lowest Oxygen Cerebral
Saturation
%
%
Maximum Drop of Regional Oxygen
Cerebral Saturation During Circulatory
Arrest
P.Totaro… Safety of unilateral cerebral perfusion…
CROCS
Cumulative Reduction of Regional Oxygen Cerebral Saturation >25
baseline
Percentage
%
Minute
min
P.Totaro… Intermittent circulatory arrest ...
Conclusions
Continuous NIRS monitoring during uSACP did not show any
significant differences when compared to bSACP
These data seems to confirm that in the majority of patients uSACP
should warranty adeguate cerebral perfusion and protection during
aortic surgery