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Anesthesia for Surgery of the Ascending Aorta and Aortic Arch

  • Andrew W. Murray
  • Kathirvel Subramaniam
Chapter

Abstract

Disease of the ascending aorta is always a serious development in any patient. The nature of the ­disease and the severity of the particular disease will typically determine whether the patient will ultimately have to proceed with immediate ­surgical intervention or observation and medical management.

Keywords

Aortic Dissection Tranexamic Acid Bicuspid Aortic Valve Aortic Surgery Axillary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Roman MJ, Devereux RB, Kramer-Fox R, O’Loughlin J. Two dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol. 1989;64:507–512.CrossRefPubMedGoogle Scholar
  2. 2.
    Bickerstaff LK, Pairolero PC, Hollier LH, et al. Thoracic aortic aneurysms: a population based study. Surgery. 1982;92:1103–1109.PubMedGoogle Scholar
  3. 3.
    Chen K, Varon J, Wenker OC, et al. Acute thoracic aortic dissection: the basics. J Emerg Med. 1997;15:859–867.CrossRefPubMedGoogle Scholar
  4. 4.
    Muller JP, Reuthebuch O, Jenni R, Turina MI. Pseudoaneurysm of the left ventricle near the non-coronary sinus valsalvae after aortic valve replacement. Eur J Cardiothorac Surg. 2004;25:283.CrossRefPubMedGoogle Scholar
  5. 5.
    Yasuda H, Sakagoshi N, Lim YJ, Mishima M. Pseudoaneurysm after Bentall operation diagnosed by transesophageal echocardiography. Ann Thorac Surg. 2004;78:1478.CrossRefPubMedGoogle Scholar
  6. 6.
    Dhadwal AK, Abrol S, Zisbrod Z, Cunningham JN Jr. Pseudoaneurysms of the ascending aorta following coronary artery bypass surgery. J Card Surg. 2006;21:221–224.CrossRefPubMedGoogle Scholar
  7. 7.
    Erkut B, Ceviz M, Becit N, Gundogdu F, Unlu Y, Kantarci M. Pseudoaneurysm of the left coronary ostial anastomoses as a complication of the modified Bentall procedure diagnosed by echocardiography and multislice computed tomography. Heart Surg Forum. 2007;10:E191–E192.CrossRefPubMedGoogle Scholar
  8. 8.
    Jault F, Rama A, Cluzel P, et al. Pseudo-aneurysms of the ascending aorta in patients previously operated for acute aortic dissection. Arch Mal Coeur Vaiss. 2005;98:20–24.PubMedGoogle Scholar
  9. 9.
    Sanz O, San Román JA, Vilacosta I, et al. Clinical profile and prognosis of patients with endocarditis and periannular pseudoaneurysms. Rev Esp Cardiol. 2001;54:181–185.PubMedGoogle Scholar
  10. 10.
    Belkin RN, Kalapatapu SK, Lafaro RJ, Ramaswamy G, McClung JA, Cohen MB. Atherosclerotic pseudoaneurysm of the ascending aorta. J Am Soc Echocardiogr. 2003;16:367–369.CrossRefPubMedGoogle Scholar
  11. 11.
    Staatz G, Bücker A. Spontaneous nontraumatic ­rupture of the descending thoracic aorta with development of a giant pseudoaneurysm. J Vasc Interv Radiol. 2001;12:394–395.CrossRefPubMedGoogle Scholar
  12. 12.
    Harris KM, Malenka DJ, Plehn JF. Transesophageal echocardiographic evaluation of aortitis. Clin Cardiol. 1997;20:813–815.CrossRefPubMedGoogle Scholar
  13. 13.
    Bezerra Lira-Filho E, Campos O, Lazaro Andrade J, et al. Thoracic aorta evaluation in patients with Takayasu’s arteritis by transesophageal echocardiography. J Am Soc Echocardiogr. 2006;19:829–834.CrossRefPubMedGoogle Scholar
  14. 14.
    Fleck TM, Czerny M, Hutschala D, et al. The incidence of transient neurologic dysfunction after ascending aortic replacement with circulatory arrest. Ann Thorac Surg. 2003;76:1198–1202.CrossRefPubMedGoogle Scholar
  15. 15.
    Hagl C, Ergin MA, Galla JD, et al. Neurologic ­outcome after ascending aortic-aortic arch operations effect of brain protection technique in high risk patients. J Thorac Cardiovasc Surg. 2001;121:1107–1121.CrossRefPubMedGoogle Scholar
  16. 16.
    Gravlee GP, Brauer SD, O’Rourke MF, Avolio AP. A comparison of brachial, femoral, and aortic intra-arterial pressures before and after cardiopulmonary bypass. Anaesth Intensive Care. 1989;17:305–311.PubMedGoogle Scholar
  17. 17.
    Bazaral MG, Welch M, Golding LA, Badhwar K. Comparison of brachial and radial arterial pressure monitoring in patients undergoing coronary artery bypass surgery. Anesthesiology. 1990;73:38–45.CrossRefPubMedGoogle Scholar
  18. 18.
    Usui A, Abe T, Murase M. Early clinical results of retrograde perfusion for aortic arch operations in Japan. Ann Thorac Surg. 1996;62:94–104.CrossRefPubMedGoogle Scholar
  19. 19.
    Ganzel B, Edmonds HJ Jr, Pank JR, Goldsmith LJ. Neurophysiological monitoring to assure delivery of retrograde cerebral perfusion. J Thorac Cardiovasc Surg. 1997;113:748–755.CrossRefPubMedGoogle Scholar
  20. 20.
    Davila-Roman VG, Barzilai B, Wareing TH, Murphy SF, Kouchoukos NT. Intraoperative ultrasonographic evaluation of the ascending aorta in 100 consecutive patients undergoing cardiac surgery. Circulation. 1991;84(Supplement 5):III 47–III 53.Google Scholar
  21. 21.
    Flachskampf FA. Assessment of aortic dissection and hematoma. Semin Cardiothorac Vasc Anesth. 2006;10:83–88.CrossRefPubMedGoogle Scholar
  22. 22.
    Ergin MA. Hypothermic circulatory arrest. In: Coselli JS, Lemaire SA, eds. Aortic Arch Surgery. Principles,Strategies and Outcomes. 1st ed. Hoboken, NJ: Wiley-Blackwell; 2008:135–152.CrossRefGoogle Scholar
  23. 23.
    Johnson JM, Robins S, Hyde J. Monitoring and safety in cardiopulmonary bypass. In: Kay PH, Munsch CM, eds. Techniques in Extracorporeal Circulation. 4th ed. London, Great Britain: Arnold; 2004:76–98.Google Scholar
  24. 24.
    Kaukuntla H, Harrington D, Bilkoo I, et al. Temperature monitoring during cardiopulmonary bypass– do we undercool or overheat the brain? Eur J Cardiothorac Surg. 2004;26:580–585.CrossRefPubMedGoogle Scholar
  25. 25.
    Akata T, Yamaura K, Kandabashi T, Sadamatsu S, Takahashi S. Changes in body temperature during profound hypothermic cardiopulmonary bypass in adult patients undergoing aortic arch reconstruction. J Anesth. 2004;18:73–81.CrossRefPubMedGoogle Scholar
  26. 26.
    Akata T, Setoguchi H, Shirozu K, Yoshino J. Reliability of temperatures measured at standard monitoring sites as an index of brain temperature ­during deep hypothermic cardiopulmonary bypass conducted for thoracic aortic reconstruction. J Thorac Cardiovasc Surg. 2007;133:1559–1565.CrossRefPubMedGoogle Scholar
  27. 27.
    Bond DM, Milne B, Pym J, Sandler D. Cardiac tamponade complicating anaesthetic induction for repair of ascending aorta dissection. Can J Anaesth. 1987;34:291–293.CrossRefPubMedGoogle Scholar
  28. 28.
    Edmonds HL. Advances in neuromonitoring forcardiothoracic and vascular surgery. J Cardiothorac Vasc Anesth. 2001;15:241–250.CrossRefPubMedGoogle Scholar
  29. 29.
    Cooper JR. Anesthetic management. In: Coselli JS, Lemaire SA, eds. Aortic arch Surgery. Principles, Strategies and Outcomes. Hoboken, NJ: Wiley-Blackwell; 2007:91–97.Google Scholar
  30. 30.
    Cooper JR, Slogoff S. Thoracic aortic surgery. In: Yeager MP, Glass DD, eds. Anesthesiology and Vascular Surgery. Norwalk, CN: Appleton and Lange; 1990:185–210.Google Scholar
  31. 31.
    Paparella D, Brister SJ, Buchanan M. Coagulation disorders of cardiopulmonary bypass: a review. Intensive Care Med. 2004;30:1873–1881.CrossRefPubMedGoogle Scholar
  32. 32.
    Hartmann M, Sucker C, Boehm O, Koch A, Loer S, Zacharowski KC. Effects of cardiac surgery on hemostasis. Transfus Med Rev. 2006;20:230–241.CrossRefPubMedGoogle Scholar
  33. 33.
    Muriithi EW, Belcher PR, Menys VC, et al. Heparin-induced platelet dysfunction and cardiopulmonary bypass. Ann Thorac Surg. 2000;69:1827–1832.CrossRefPubMedGoogle Scholar
  34. 34.
    Westaby S. Coagulation disturbance in profound hypothermia: the influence of anti-fibrinolytic therapy. Semin Thorac Cardiovasc Surg. 1997;9:246–256.PubMedGoogle Scholar
  35. 35.
    Wilde JT. Hematological consequences of profound hypothermic circulatory arrest and aortic dissection. J Card Surg. 1997;12:201–206.CrossRefPubMedGoogle Scholar
  36. 36.
    Rundgren M, Engstrom M. A thromboelastometric evaluation of the effects of hypothermia on the coagulation system. Anesth Analg. 2008;107:1465–1468.CrossRefPubMedGoogle Scholar
  37. 37.
    Reston JT, Tregear SJ, Turkelson CM. Meta-analysis of short term and mid-term outcomes following off-pump coronary artery bypass grafting. Ann Thorac Surg. 2003;76:1510–1515.CrossRefPubMedGoogle Scholar
  38. 38.
    Christman JW, Lancaster LH, Blackwell TS. Nuclear factor Kappa B: a pivotal role in the systemic inflammatory response syndrome and new target for therapy. Intensive Care Med. 1998;24:1131–1138.CrossRefPubMedGoogle Scholar
  39. 39.
    Baldwin AS. The NF-kappa B and I kappa B proteins: new discoveries and insights. Annu Rev Immunol. 1996;14:649–683.CrossRefPubMedGoogle Scholar
  40. 40.
    Despotis GJ, Joist JH, Hogue CW Jr, et al. The impact of heparin concentration and activated clotting time monitoring on blood conservation. A prospective, randomized evaluation in patients undergoing cardiac operation. J Thorac Cardiovasc Surg. 1995;110:46–54.CrossRefPubMedGoogle Scholar
  41. 41.
    Despotis GJ, Joist JH, Hogue CW Jr, et al. More effective suppression of hemostatic system in patients undergoing cardiac surgery by heparin dosing based on heparin blood concentrations rather that ACT. Thromb Haemost. 1996;76:902–908.PubMedGoogle Scholar
  42. 42.
    Okita Y, Takamoto S, Ando M, et al. Coagulation and fibrinolysis system in aortic surgery under deep hypothermic circulatory arrest with aprotinin: the importance of adequate heparinization. Circulation. 1997;96(Suppl 2):376–381.Google Scholar
  43. 43.
    Ganter MT, Hofer CK. Coagulation monitoring: current techniques and clinical use of viscoelastic point of care coagulation devices. Anesth Analg. 2008;106:1366–1375.CrossRefPubMedGoogle Scholar
  44. 44.
    Wang JS, Lin CY, Hung WT, et al. Thromboelastogram fails to predict postoperative hemorrhage in cardiac patients. Ann Thorac Surg. 1992;53:435–439.CrossRefPubMedGoogle Scholar
  45. 45.
    Mengistu AM, Wolf MW, Boldt J, et al. Evaluation of a new platelet function analyzer in cardiac surgery: a comparison of modified thromboelastography and whole blood aggregometry. J Cardiothorac Vasc Anesth. 2008;22:40–46.CrossRefPubMedGoogle Scholar
  46. 46.
    Cammerer U, Dietrich W, Rampf T, et al. The predictive value of modified computerized thromboelastography and platelet function analysis for postoperative blood loss in routine cardiac surgery. Anesth Analg. 2003;96:51–57.CrossRefPubMedGoogle Scholar
  47. 47.
    Gorlinger K, Herold U, Jacob H, et al. ROTEM based coagulation management in acute type A dissection: medical and economical aspects. J Anast Intensivbeh. 2007;14:89–90.Google Scholar
  48. 48.
    Shore-Lesserson L. Evidence based coagulation monitors: heparin monitoring, thromboelastography and platelet function. Semin Cardiothorac Vasc Anesth. 2005;9:41–52.CrossRefPubMedGoogle Scholar
  49. 49.
    Shibata K, Takamoto S, Kotsuka Y, Sato H. Effectiveness of combined blood conservation measures in thoracic aortic operations with deep hypothermic circulatory arrest. Ann Thorac Surg. 2002;73:739–743.CrossRefPubMedGoogle Scholar
  50. 50.
    Svensson LG, Sun J, Nadolny E, Kimmel WA. Prospective evaluation of minimal blood use for ascending aorta and aortic arch operations. Ann Thorac Surg. 1995;59:1501–1508.CrossRefPubMedGoogle Scholar
  51. 51.
    Apaydin AZ, Buket S, Posacioglu H, et al. Perioperative risk factors for mortality in patients with acute Type A aortic dissection. Ann Thorac Surg. 2002;74:2034–2039.CrossRefPubMedGoogle Scholar
  52. 52.
    Society of Thoracic Surgeons Blood Conservation Guideline Task Force, VA, Ferraris SP, Saha SP et al. Society of Cardiovascular Anesthesiologists Special Task Force on Blood Transfusion, Spiess BD, Shore-Lesserson L, Stafford-Smith M et al. Perioperative Blood Transfusion and blood conservation in cardiac surgery. The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists clinical practice guidelines. Ann Thorac Surg. 2007;83(5 Suppl):S27–86.Google Scholar
  53. 53.
    Dacey LJ, Munoz JJ, Baribeau YR, et al. Reexploration for hemorrhage following coronary artery bypass grafting: incidence and risk factors. Northern New England cardiovascular disease study group. Arch Surg. 1998;133:442–447.CrossRefPubMedGoogle Scholar
  54. 54.
    Moulton MJ, Creswell LL, Mackey ME, Cox JL, Rosenbloom M. Reexploration for bleeding is a risk factor for adverse outcomes after cardiac operations. J Thorac Cardiovasc Surg. 1996;111:1037–1046.CrossRefPubMedGoogle Scholar
  55. 55.
    Casati V, Sandreli L, Speziali G, et al. Hemostatic effects of tranexamic acid in elective thoracic aortic surgery: A prospective, randomized, double blind, placebo-controlled study. J Thorac Cardiovasc Surg. 2002;123:1084–1091.CrossRefPubMedGoogle Scholar
  56. 56.
    Shimamura Y, Nakajima M, Hirayama T, et al. The effect of intraoperative high-dose tranexamic acid on blood loss after operation for acute aortic dissection.J Thorac Cardiovasc Surg. 1998;46:616–621.Google Scholar
  57. 57.
    Boldt J, Schindler E, Osmer C, et al. Influence of different anticoagulation regimens on platelet function during cardiac surgery. Br J Anaesth. 1994;73:639–644.CrossRefPubMedGoogle Scholar
  58. 58.
    Stundt TM, Kouchoukos NT, Saffitz JE, et al. Renal dysfunction and intravascular coagulation with aprotinin and hypothermic circulatory arrest. Ann Thorac Surg. 1993;55:1418–1424.CrossRefGoogle Scholar
  59. 59.
    Westaby S, Forni A, Dunning J, et al. Aprotinin and bleeding in profoundly hypothermic perfusion. Eur J Cardiothorac Surg. 1994;8:82–86.CrossRefPubMedGoogle Scholar
  60. 60.
    Parolari A, Antona C, Alamanni F, et al. Aprotinin and deep hypothermic circulatory arrest: there are no benefits even when appropriate amounts of heparin are given. Eur J Cardiothorac Surg. 1997;11:149–156.CrossRefPubMedGoogle Scholar
  61. 61.
    Mora Mangano CT, Neville MJ, Hsu PH, et al. Aprotinin, blood loss, and renal dysfunction in deep hypothermic circulatory arrest. Circulation. 2001;104(12 Suppl 1):I276–I281.PubMedGoogle Scholar
  62. 62.
    Eaton MP, Deeb GM. Aprotinin versus epsilon-aminocaproic acid for aortic surgery using deep hypothermic circulatory arrest. J Cardiothorac Vasc Anesth. 1998;12:548–552.CrossRefPubMedGoogle Scholar
  63. 63.
    Fontes M, Girardi L, Koval K, et al. Post aprotinin era: Is aminocaproic acid as good in complex aortic surgery. Anesth Analg. 2009;108(SCA Suppl):A3.Google Scholar
  64. 64.
    Nicolau-Raducu RE, Subramaniam K, Marquez J, Hilmi IA, Sullivan EA. Safety of high dose tranexamic acid compared with aprotinin in thoracic aortic surgery. Anesthesiology. 2008;109:A1622.Google Scholar
  65. 65.
    Fergusson DA, Hebert PC, Mazer CD, et al. (BART study). A comparison of aprotinin and lysine analogues in high-risk cardiac surgery. N Engl J Med. 2008;358:2319–2331.CrossRefPubMedGoogle Scholar
  66. 66.
    Shimazaki Y, Watanabe T, Takahashi T, et al. Minimized mortality and neurological complications in surgery for chronic arch aneurysm. J Card Surg. 2004;19:339–342.CrossRefGoogle Scholar
  67. 67.
    Fusco DS, Shaw RK, Tranquilli M, et al. Femoral cannulation is safe for type A dissection repair. Ann Thorac Surg. 2004;78:1285–1289.CrossRefPubMedGoogle Scholar
  68. 68.
    Reuthebuch O, Schurr U, Hellermann J, et al. Advantages of subclavian artery perfusion for repair of acute type A dissection. Eur J Cardiothorac Surg. 2004;26:592–598.CrossRefPubMedGoogle Scholar
  69. 69.
    Moizumi Y, Motoyoshi N, Sakuma K, Yoshida S. Axillary artery cannulation improves operative results for acute type a aortic dissection. Ann Thorac Surg. 2005;80:77–83.CrossRefPubMedGoogle Scholar
  70. 70.
    Pasic M, Schubel J, Bauer M, et al. Cannulation of the right axillary artery for surgery of acute type A aortic dissection. Eur J Cardiothorac Surg. 2003;24:231–235.CrossRefPubMedGoogle Scholar
  71. 71.
    Strauch JT, Spielvogel D, et al. Axillary artery cannulation: routine use in ascending aorta and aortic arch replacement. Ann Thorac Surg. 2004;78:103–108.CrossRefPubMedGoogle Scholar
  72. 72.
    Svensson LG, Blackstone EH, Rajeswaran J, et al. Does the arterial cannulation site for circulatory arrest influence stroke risk? Ann Thorac Surg. 2004;78:1274–1284.CrossRefPubMedGoogle Scholar
  73. 73.
    Katoh T, Gohra H, Hamano K, Takenaka H, Zempo N, Esato K. Right axillary cannulation in the left thoracotomy for thoracic aortic aneurysm. Ann Thorac Surg. 2000;70:311–313.CrossRefPubMedGoogle Scholar
  74. 74.
    Neri E, Massetti M, Barabesi L, et al. Extrathoracic cannulation of the left common carotid artery in thoracic aorta operations through a left thoracotomy: preliminary experience in 26 patients. J Thorac Cardiovasc Surg. 2002;123:901–910.CrossRefPubMedGoogle Scholar
  75. 75.
    Turkoz R, Gulcan O, Demirturk OS, Turkoz A. Cannulation of the ascending aorta in left thoracotomy for thoracic aortic aneurysms. Heart Surg Forum. 2007;10:E81–E83.CrossRefPubMedGoogle Scholar
  76. 76.
    Yamada T, Yamazato A. Central cannulation for type A acute aortic dissection. Interact Cardiovasc Thorac Surg. 2003;2:175–177.CrossRefPubMedGoogle Scholar
  77. 77.
    Reece TB, Tribble CG, Smith RL, et al. Central cannulation is safe in acute aortic dissection repair. J Thorac Cardiovasc Surg. 2007;133:428–434.CrossRefPubMedGoogle Scholar
  78. 78.
    Inoue Y, Ueda T, Taguchi S, et al. Ascending aortic cannulation in acute type A aortic dissection. European Journal of Cardio-thoracic Surgery. 2006;31:976–981.CrossRefGoogle Scholar
  79. 79.
    Khaladj N, Shrestha M, Peterss S, et al. Ascending aortic cannulation in acute aortic dissection type A: the Hannover experience. Eur J Cardiothorac Surg. 2008;34:792–796.CrossRefPubMedGoogle Scholar
  80. 80.
    Khoynezhad A, Plestis K. Cannulation in the diseased aorta. A safe approach using the Seldinger technique. Tex Heart Inst J. 2006;33:353–355.PubMedGoogle Scholar
  81. 81.
    Wada S, Yamamoto S, Honda J. Transapical aortic cannulation for cardiopulmonary bypass in type A aortic dissection operations. J Thorac Cardiovasc Surg. 2006;132:369–372.CrossRefPubMedGoogle Scholar
  82. 82.
    Svensson LG. Progress in ascending and aortic arch surgery: minimally invasive surgery, blood conservation, and neurological deficit prevention. Ann Thorac Surg. 2002;74:S1786–S1788.CrossRefPubMedGoogle Scholar
  83. 83.
    Dorotta I, Kimball-Jones P, Applegate R 2nd. Deep hypothermia and circulatory arrest in adults. Semin Cardiothorac Vasc Anesth. 2007;11:66–76.CrossRefPubMedGoogle Scholar
  84. 84.
    Dr Gorlinger K. Point of care coagulation-ROTEM. 11th International Congress of Cardiothoracic and Vascular Anesthesia, Berlin, Germany, 14–18 September 2008Google Scholar
  85. 85.
    Mazzola A, Gregorini R, Villani C, Di Eusanio M. Antegrade cerebral perfusion by axillary artery and left carotid artery inflow at moderate hypothermia. Eur J Cardiothorac Surg. 2002;21(5):930–931.CrossRefPubMedGoogle Scholar
  86. 86.
    Bonser RS, Harrington DK. Retrograde cerebral perfusion. In: Coselli JS, Lemaire SA, eds. Aortic Arch Surgery. Principles, Strategies and Outcomes. 1st ed. Hoboken: Wiley- Blackwell; 2008:167–176.CrossRefGoogle Scholar

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© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Department of AnesthesiologyUniversity of Pittsburgh Medical Center – Presbyterian and VA HospitalPittsburghUSA

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