IRCCS “Foundation Hospital S Matteo”

SAFETY OF UNILATERAL Vs BILATERAL

CEREBRAL PERFUSION DURING AORTIC

SURGERY ASSESSED USING REGIONAL

CEREBRAL OXYGEN SATURATION

MONITORING

IRCCS “Foundation Hospital S Matteo”

Totaro PParis M

Amoroso F

Milanesi E

Maurelli M

Vigano’ M

Pavia

Selective Antegrade Cerebral Perfusion (SACP) has probably become the

gold standard for cerebral protection during aortic surgery.

Background

However

Some technical aspects related to the management of SACP remain

controversial .

Open Issues

Site of Arterial Cannulation

Unilateral Bilateral

Degree of Hypothermia

Extension of SACP

P.Totaro… Safety of unilateral cerebral perfusion…

ATS 2009

Background

ATS 2010


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 60

Sex Male Female

23 (38)37 (62)

Age at operation 65±14

BSA 1.8±0.2

Aortic Dissection 30 (50)

Surgical Details

Patients 60

Arterial Cannulation Axillary Femoral

54 (90)6 (10)

Deep Hypothermia 6 (10)

SACP bSCAP (Group A) uSCAP (Group B)

23 (38)37 (62)

NIRS Monitoring Background



PRO CONS

- Easy to manage

- Easy Interpretation

- Cost-effective

- Reproducible

- No dedicated technician

- Allows for prompt action

- Still under-utilized

- Sensitive to the location

- No significant difference shown in terms of action

- No correlation to neurological impairment following CABG

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


NIRS Advanced Analysis

CROCSCROCS CCumulative umulative RReduction of Regional eduction of Regional OOxygen xygen CCerebral erebral SSaturation >25 %aturation >25 %

MOCSMOCSOverall Overall MMean ean OOxygen xygen CCerebral erebral SSaturationaturation

MDDCAMDDCA MMaximum aximum DDrop of Regional Oxygen Cerebral rop of Regional Oxygen Cerebral Saturation Saturation DDuring uring CCirculatory irculatory AArrestrrest

LOCSLOCSLLowest owest OOxygen xygen CCerebral erebral SSaturationaturation


Parameter Group AbSACP

Group BuSACP

p

Patients 23 37

Sex 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

BSA 1.77±0.23 1.85±0.22 0,16

Results Groups were homogeneous for preoperative characteristics

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

Surgical Parameters


MOCSMOCS

Overall Overall MMean ean OOxygen xygen CCerebral erebral SSaturationaturation

%

Near Infra-Red Spectroscopy

Results

Baseline

%


%

LOCSLOCS

LLowest owest OOxygen xygen CCerebral erebral SSaturationaturation

MDDCAMDDCA

MMaximum aximum DDrop of Regional Oxygen rop of Regional Oxygen Cerebral Saturation Cerebral Saturation DDuring uring CCirculatory irculatory AArrestrrest

%


%

CROCSCROCS CCumulative umulative RReduction of Regional eduction of Regional OOxygen xygen CCerebral erebral SSaturation >25 aturation >25 baselinebaseline

min

Percentage Minute

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

Documents

IRCCS “Foundation Hospital S Matteo”