NL
DE
Open aortic arch surgery necessitates a period of circulatory arrest. The brain is, due to its high demand for oxygen-rich blood, particularly vulnerable to this procedure. Ultimately, insufficient levels of cerebral blood flow may cause brain damage and complications. Cerebral perfusion techniques are used to monitor cerebral blood flow. Despite these technical advancements however, rates of neurological complications following aortic arch surgery, remain high.
A few years ago, Ralf Weijs and Dick Thijssen from the department of Medical BioSciences travelled to Nieuwegein to set up a research collaboration with the St. Antonius Hospital. As part of standard care in that hospital, measurements of cerebral blood flow were performed before and during aortic arch surgery. In-house neurologist Selma Tromp and cardio-thoracic surgeon Robin Heijmen, who in the meantime has become head of the department of Cardio-thoracic Surgery in our Radboudumc, were enthusiastic from the very first moment. Brain damage following aortic arch surgery involving cerebral perfusion techniques deserves special attention. Jurgen Claassen from the department of Geriatric Medicine was, as Ralf Weijs’ co-promotor, closely involved in the execution of the study, as well as in-house clinical experts from the St. Antonius Hospital.
Data from 102 patients that underwent aortic arch surgery involving a cerebral perfusion technique (ASCP) between 2017-2020 in the St. Antonius Hospital were retrospectively analysed. It was found that cerebral blood flow levels are lower during surgery under general anaesthesia when compared to preoperative physiological levels. More importantly, lower cerebral perfusion during surgery was independently associated with the development of postoperative delirium and/or ischemic stroke. This highlights the clinical potential of monitoring and preventing too low cerebral blood flow during surgery for the prevention of neurological complications, although this needs further research.
Publication
Weijs RWJ, Tromp SC, Heijmen RH, Seeber AA, van Belle-van Haaren NJCW, Claassen JAHR, Thijssen DHJ. Perioperative cerebral perfusion in aortic arch surgery: a potential link with neurological outcome. Eur J Cardiothorac Surg. 2023 Jun 1;63(6):ezad144. doi: 10.1093/ejcts/ezad144. PMID: 37052672; PMCID: PMC10264368.
