Impact of cerebral protection strategy used during open surgical aortic arch replacement on visceral function
by Saddam Mohammed Ahmed Al-Sabri
Date of Examination:2020-04-07 // postponed to 2020-06-02
Date of issue:2020-03-10
Advisor:Prof. Dr. Bernhard Danner
Referee:Prof. Dr. Anselm Bräuer
Referee:Prof. Dr. Martin Oppermann
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Abstract
English
The purpose of the current investigation was to determine how different approaches of cerebral protection (DHCA, ACP and RCP) influence abdominal organ function after open surgical aortic arch replacement and establish relationships to operative mortality, clinical outcome, and long-term survival. Demographic data, pre-operative and operative characteristics as well as post-operative markers of visceral function were retrospectively analyzed in 128 patients with acquired aortic arch disease who underwent open surgical aortic arch replacement under DHCA(n=37), ACP(n=70) or RCP(n=21) between June 2005 and March 2016 at the Department of Thoracic, Cardiac and Vascular Surgery, University of Göttingen, Germany. There were no significant differences between the three groups of patients in terms of demographic data, clinical status, disease extension, characteristics of the surgical techniques, operative times and need for revision. However, DHCA patients required significantly more catecholamine support during the post-operative period than ACP or RCP patients. GPT, Lactate and Creatine kinase seem to be sensitive markers of early post-operative visceral damage whereas GGT, Bilirubin and AP are markers of delayed visceral dysfunction. Higher pre-operative lactate levels, as well as early post-operative increase in plasma lactate and CK were associated with mortality in all groups independently of type of intra-operative perfusion used. Therefore, ACP and RCP offer no significant protection of abdominal viscera during circulatory arrest. Their main advantage seems to remain in the field of cerebral protection. The main protector of visceral organs seems to be deep hypothermia that was similarly applied in all three groups.
Keywords: cerebral protection strategy; open surgical aortic arch replacement; visceral function