Post on 11-Jan-2016
description
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
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 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
P.Totaro… Safety of unilateral cerebral perfusion…
P.Totaro… Safety of unilateral cerebral perfusion…
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
P.Totaro… Safety of unilateral cerebral perfusion…
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
P.Totaro… Safety of unilateral cerebral perfusion…
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
P.Totaro… Safety of unilateral cerebral perfusion…
MOCSMOCS
Overall Overall MMean ean OOxygen xygen CCerebral erebral SSaturationaturation
%
Near Infra-Red Spectroscopy
Results
Baseline
%
P.Totaro… Safety of unilateral cerebral perfusion…
%
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
%
P.Totaro… Safety of unilateral cerebral perfusion…
%
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