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IRCCS “Foundation Hospital S Matteo”

SAFETY OF UNILATERAL Vs BILATERAL CEREBRAL PERFUSION DURING AORTIC SURGERY ASSESSED USING REGIONAL CEREBRAL OXYGEN SATURATION MONITORING. Totaro P Paris M Amoroso F Milanesi E Maurelli M Vigano’ M. IRCCS “Foundation Hospital S Matteo”. Pavia. Background.

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IRCCS “Foundation Hospital S Matteo”

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  1. SAFETY OF UNILATERAL Vs BILATERAL CEREBRAL PERFUSION DURING AORTIC SURGERY ASSESSED USING REGIONAL CEREBRAL OXYGEN SATURATION MONITORING Totaro P Paris M Amoroso F Milanesi E Maurelli M Vigano’ M IRCCS “Foundation Hospital S Matteo” Pavia

  2. Background Selective Antegrade Cerebral Perfusion (SACP) has probably become the gold standard for cerebral protection during aortic surgery. However Some technical aspects related to the management of SACP remain controversial . Open Issues Site of Arterial Cannulation Degree of Hypothermia Extension of SACP Unilateral Bilateral

  3. P.Totaro… Safety of unilateral cerebral perfusion… Background ATS 2009 ATS 2010

  4. 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) Surgical Details

  5. P.Totaro… Safety of unilateral cerebral perfusion… NIRS Monitoring Background

  6. P.Totaro… Safety of unilateral cerebral perfusion… CONS PRO - 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

  7. P.Totaro… Safety of unilateral cerebral perfusion… NIRS Advanced Analysis MOCS OverallMeanOxygenCerebralSaturation CROCS Cumulative ReductionofRegionalOxygenCerebralSaturation >25 % LOCS LowestOxygenCerebralSaturation MDDCA MaximumDropofRegionalOxygenCerebralSaturationDuringCirculatoryArrest

  8. P.Totaro… Safety of unilateral cerebral perfusion… Results Groups were homogeneous for preoperative characteristics Surgical Parameters

  9. P.Totaro… Safety of unilateral cerebral perfusion… Results Near Infra-Red Spectroscopy MOCS OverallMeanOxygenCerebralSaturation Baseline % %

  10. P.Totaro… Safety of unilateral cerebral perfusion… MDDCA LOCS MaximumDropofRegionalOxygenCerebralSaturationDuringCirculatoryArrest LowestOxygenCerebralSaturation % %

  11. P.Totaro… Safety of unilateral cerebral perfusion… Cumulative ReductionofRegionalOxygenCerebralSaturation >25 baseline CROCS Percentage Minute % min

  12. 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

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