Zusammenfassung
Die chirurgische Behandlung von Aortenbogenaneurysmen ist trotz zunehmender medizinischer Expertise auch heute noch mit signifikanter Morbidität und Mortalität assoziiert. Dabei sind insbesondere neurologische Schäden von entscheidendem Belang.
Zur besseren Protektion des Zerebrums wurden deshalb neben dem isolierten hypothermen Kreislaufstillstand in den letzten Jahren eine Reihe von additiven Verfahren etabliert, die im Wesentlichen auf eine Verringerung der Ischämiezeit abzielen. Darüber hinaus existieren sowohl klinisch als auch experimentell eine Vielzahl weiterer Ansätze, deren Bewertung jedoch verschiedenster Gründe wegen nicht unproblematisch ist.
Die vorliegende Arbeit vermittelt, basierend auf den Erfahrungen der eigenen Arbeitsgruppe, einen groben Überblick über derzeit gängige klinische Verfahren zur Neuroprotektion. Zudem werden experimentell bearbeitete Ansätze kritisch diskutiert und auf deren potenzielle Anwendbarkeit in der Klinik hin überprüft.
Abstract
Surgery of the aortic arch requiring hypothermic circulatory arrest is still associated with substantial morbidity and mortality. In many cases this is due to neurological sequelae as a result of embolic events or imperfect cerebral protection. With increasing expertise, various cerebral protection techniques have been introduced over time. Most of them still rely on hypothermic circulatory arrest, but selective perfusion techniques can be added. The idea behind this concept is to reduce the ischemic time of the brain to gain more time for the treatment of complexpathologies. There are a number of other experimental or clinical strategies for neuroprotection. The interpretation of the results is not without problems.
This paper includes a synopsis of different cerebral protection techniques as used in many cardiothoracic centers. Furthermore it gives an overview of various experimental approaches.
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Hagl, C., Khaladj, N., Peterß, S. et al. Neuroprotektion in der Aortenbogenchirurgie: Experimentelle Untersuchungen und klinische Analyse. Z Herz- Thorax- Gefäßchir 22, 47–55 (2008). https://doi.org/10.1007/s00398-008-0609-5
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DOI: https://doi.org/10.1007/s00398-008-0609-5
Schlüsselwörter
- Aortenbogenchirurgie
- Neuroprotektion
- antegrade zerebrale Perfusion
- retrograde zerebrale Perfusion
- Überblick