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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We analyzed cases with brain damage after surgery for thoracic aortic aneurysm in our institution and investigated the causes, risk-factors and preventive measures for this disastrous postoperative complication. Irreversible brain damage was a complication in 25 out of 184 operative cases (13.6%) over a 21-year period. The cause of brain damage was determined to be embolism by manipulation of the aorta in six cases, clamping of the left subclavian artery in four cases, technical problems of separate cerebral perfusion (SCP) in four cases, severe shock in three cases, embolism unrelated to operative maneuver in three cases, stenosis of a branch of the arch with aortic dissection in two cases, and air embolism, circulatory arrest with insufficient hypothermia and hypoperfusion of a temporary bypass to the left carotid artery in one case each. The neurological symptom improved in eight cases and was unchanged in 17 cases. Eighteen cases died in the hospital. In the univariate analysis, age (p = 0.048), a portion of the aneurysm (p = 0.035), preoperative brain complication (p = 0.003), emergency operation (p = 0.033) and clamping of the arch (p = 0.001) were found to be prominent risk factors for brain damage. In the multivariate analysis, clamping of the arch (p = 0.0310), SCP (p = 0.0327) and emergency operation (p = 0.0223) were prominent. To prevent postoperative brain damage, the arch should not be clamped, appropriate operative techniques to avoid bleeding and to shorten SCP time should be employed, and proper and prompt management of the emergency operation and caution in clamping the left subclavian artery are considered to be necessary.
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PMID:[Brain damage after surgery for thoracic aortic aneurysm]. 939 76

Acute type A aortic dissection in the presence of a previously repaired atherosclerotic descending thoracic aortic aneurysm is rarely reported. We experienced a patient who underwent an ascending aortic replacement with reconstruction of the aortic arch 16 months after repair of a descending thoracic aortic aneurysm. We succeeded in the redo operation with comprehensive techniques involving selective cerebral perfusion, deep hypothermia, early antegrade systemic circulation for cerebral protection, and femoro-femoral bypass with occlusion of the descending aorta for lower systemic perfusion as well as renal perfusion. The patient recovered and is doing well one year after the redo operation.
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PMID:Successful surgery for an acute type A aortic dissection following repair of a descending thoracic aortic aneurysm. 958 73

The ruptured thoracic aortic aneurysm has had severely high mortality. A 71-year-old male who suddenly fainted away was admitted to our hospital. He was in shock on arrival. Computed tomography and echo cardiogram demonstrated ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade. Aortic arch replacement was performed using the selective cerebral perfusion under deep hypothermia. The recovery of his consciousness was delayed, and he had right hemiplegia postoperatively, but his state was improved gradually. Finally he complained only slight degree of aphasia, paralysis. An immediate and aggressive emergency operation is a only method to salvage the patient who has ruptured aneurysm of the thoracic aorta.
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PMID:[Ruptured aortic arch aneurysm with hemorrhagic cardiac tamponade: report a case]. 983 83

The utilization of cardiopulmonary bypass systems, for circulatory and/or pulmonary support of patients undergoing non-cardiac procedures, has been previously reported. There is, however, a sub-group of patients for whom total systemic anticoagulation for cardiopulmonary support is extremely undesirable or contraindicated altogether, due to the presenting pathology or procedure to be performed. Clinical and experimental reports have suggested that with the use of heparin-bonded bypass circuits, the amount of heparin required for anticoagulation of the patient may be substantially reduced, or eliminated, safely. This allows the resuscitation and/or support of patients in whom bypass would otherwise be contraindicated. We present our clinical experience with heparin-bonded, biocompatible circuits, for support of patients undergoing non-cardiac procedures. In each case, low-dose or no heparin was administered. The group includes patients with trauma related pulmonary insufficiency, pulmonary embolism, hypothermia, neurosurgery, aortic aneurysm, aortic transection, respiratory distress syndrome, pericardiectomy, and cardiogenic shock.
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PMID:Biocompatible circuits: an adjunct to non-cardiac extracorporeal cardiopulmonary support. 1014 4

A retrospective analysis of 131 cases of major vascular surgery, mainly aneurysms of the ascending and descending aorta, was undertaken to determine whether use of different bypass methods chosen according to location of the individual lesions resulted in improved results. For the 93 cases of ascending aortic aneurysm, the method for cardiac protection was improved by the use of continuous retrograde coronary sinus perfusion with cardioplegic blood. In sixteen cases with dissection involving the aortic arch, deep hypothermic circulatory arrest and continuous retrograde cerebral perfusion through the superior vena cava was employed for brain protection. The safe brain circulation arrest time was thus prolonged to the longest record of 81 minutes. Among the group of 93 cases, there were four operative and four hospital deaths, giving a mortality rate of 8.6% (8/93). For the 34 cases of descending aortic aneurysms, left heart bypass was employed to avoid ischemia of the heart, lungs, brain, and the abdominal organs; the operative mortality rate was 8.8% (3/34). In three cases of interrupted aortic arch, separate upper and lower body perfusion under deep hypothermia with low flow rate perfusion for the upper body provided the necessary conditions for radical surgery. In one patient with Budd-Chiari syndrome, a total corrective surgery was achieved under right heart bypass.
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PMID:Extracorporeal circulation for great vessels surgery: a review of 131 cases. 1015 28

A 37-year-old man with Marfan syndrome underwent four operations for extensive cardiovascular disease. He was diagnosed as having AAE, AR and DeBakey type I aortic dissection. First, Bentall operation using Piehler procedure and total aortic arch replacement using retrograde cerebral perfusion and profound hypothermia at 18 degrees C were performed on May 11, 1994. Second, repair of leakage of the right coronary artery anastomosis and grafting for the descending thoracic aortic aneurysm were performed on December 3, 1994. Y-type grafting for the AAA was performed on December 21, 1996. Last, grafting for TAAA was performed under hypothermia at a rectal temperature of 20 degrees C on November 17, 1997. This surgical strategy of staged operation for extensive cardiovascular disease in Marfan syndrome is an effective method. Regular follow-up by CT is necessary for deciding the time and method of reoperation.
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PMID:[A case report of total aortic reconstruction and choice of staged operation in Marfan syndrome]. 1051 59

There remains no consensus on the operative management of Thoracoabdominal aortic aneurysm (TAA). Our approach emphasizes operative expediency and simplicity (without circulatory assist techniques), avoiding anticoagulation and systemic hypothermia. The technique involves a fundamental clamp/sew method with specific adjuncts directed against the principle complications: epidural cooling (introduced in 1993) for spinal cord protection, regional renal hypothermia, and in-line mesenteric shunting to minimize visceral ischemia. In a cohort of over 200 TAA patients (50% Types I & II) treated during the past decade perioperative mortality has been 8% and paraparesis/paraplegia occured in 7%. These figures are halved for patients treated in elective circumstances.
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PMID:Thoracoabdominal aortic aneurysm repair: how I do it. 1051 67

Simultaneous cardiac transplantation and surgical repair of an aortic aneurysm has not been reported previously. At our institution, a 59-year-old patient with an aneurysm of the ascending aorta and aortic arch required orthotopic cardiac transplantation for end-stage cardiomyopathy. He underwent successful surgical replacement of his ascending aorta and transverse arch (in circulatory arrest and deep hypothermia) at the time of heart transplantation.
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PMID:Cardiac transplantation and simultaneous surgical repair of an aortic aneurysm. 1054 12

We reported a 62-year-old man with DeBakey IIIa dissecting aortic aneurysm involving distal aortic arch who underwent graft replacement from ascending to descending aorta using a endovascular stent graft. Median sternotomy was carried out, because of severe pleural adhesion. Endovascular stent graft composed of 30 mm Gianturco Z stent and 24 mm woven Dacron graft was inserted to descending aorta with the aid of hypothermia, systemic circulation arrest and selective cerebral perfusion. Transesophageal echocardiography was used to measure the diameter and the length of descending aorta and the graft. And ascending and total aortic arch replacement was performed with four branched woven Dacron graft. Postoperative chest CT and aortography showed satisfactory reconstruction with the thrombosed false lumens. We think placement of stent graft to descending aorta through median sternotomy is useful method when left thoracotomy is impossible or distal anastomotic site is too far for the anastomosis.
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PMID:[Graft replacement from ascending aorta to descending aorta with endovascular stent graft under median sternotomy]. 1055 91

Spinal cord protection is critical for successful outcomes after descending thoracic and thoracoabdominal aortic aneurysm repair. For descending thoracic aneurysms which end above T9, optimum protection is maintained by distal aortic perfusion via a left atrial to distal arterial bypass circuit with a centrifugal pump. In repairs of extensive thoracoabdominal aneurysms, additional measures are required of extensive thoracoabdominaal aneurysms, additional measures are required including hypothermia, intercostal artery implantation into the graft, and spinal fluid drainage.
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PMID:Spinal cord protection for thoracic aortic surgery. 1058 47


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