Cerebral Protection in Aortic Arch Surgery
Aortic arch repair surgery is a technically complex and challenging procedure to treat aortic pathologies. Despite advancements in perioperative care, detrimental neurological complications occur during or after surgery. The neurological complications increase the economic burden of healthcare, morbidity and quality of life for the patients, even if they survive. Stroke, for example, leads to an increase in healthcare and social care costs, requiring a subsequent lengthy rehabilitation. Milder neurological impairments include transient ischaemic attacks, confusion and delirium, necessitating longer intensive care and hospital stay.
Currently applied cerebral monitoring modalities are electroencephalogram and cerebral oximetry, and they are not specific enough to timely detect early cerebral ischaemia to prevent the neurological complications. S100B protein, neuron-specific enolase, and glial fibrillary acidic protein are serum markers that reflect cerebral damage, however, their applicability in the hyperacute setting is limited. Recent studies reveal more sensitive biomarkers of glucose, lactate, pyruvate, glutamate and glycerol. These biomarkers could potentially detect cerebral ischaemia on a real time basis using continuous microdialysis method. The primary aim of the project is to develop a bedside system to continuously monitor and detect cerebral ischaemia on a real time basis during surgery and in the intensive care unit.
Central venous catheters are routinely used to monitor central venous pressure, sampling blood and administration of medications during surgery and intensive care stay. Microdialysis catheter can collect blood dialysate directly from the central venous catheter, and cerebral ischaemic biomarkers can be monitored continuously. Immediate detection of cerebral ischaemia could mandate more aggressive cerebral protection strategies by further optimisation of hypothermia and antegrade selective cerebral perfusion during surgery, and optimisation of blood pressure and oxygenation in the intensive care unit. Ultimately, early detection of cerebral ischemia using microdialysis during surgery will prevent disabling and costly neurological complications following surgery.
|Condition or Disease||Intervention/Treatment||Phase|
Arms and Interventions
|Patients with Aortic Arch Pathology
Patients undergoing aortic arch surgery for aortic arch pathologies, such as aortic aneurysm and aortic dissection.
Monitoring real-time cerebral biomarkers using microdialysis method
Primary Outcome Measures
- Number of participants with postoperative stroke [From the start of surgery until patient is discharged from the hospital, an average of 7 days]
New onset stroke after surgery
Secondary Outcome Measures
- Number of participants with postoperative delirium [From the start of surgery until patient is discharged from the hospital, an average of 7 days]
New onset delirium after surgery will be assessed using the "Confusion Assessment Method (CAM)"
Patients undergoing aortic arch surgery
Patients aged 18 and over
Patients who are able to provide informed consent
Patients with intraoperative death
Patients with preoperative neurological dysfunction
Patients who are not able to provide informed consent (language barrier, unconscious, unable to understand, retain and process information)
Contacts and Locations
LocationsNo locations specified.
Sponsors and Collaborators
- Barts & The London NHS Trust
- Queen Mary University of London
- Imperial College London
- Principal Investigator: Aung Ye Oo, MD, FRCS-CTh, Queen Mary University London
Study Documents (Full-Text)None provided.