University of Twente Student Theses


Cerebral perfusion disorders in aortic arch surgery: a multimodal approach

Stouten, S. (2021) Cerebral perfusion disorders in aortic arch surgery: a multimodal approach.

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Abstract:The aim of this thesis was to study cerebral perfusion in patients undergoing aortic arch surgery to gather insights in possible causes of PND. A retrospective study is performed to determine the correlation between vital parameters and neurological complications in patients that underwent aortic arch surgery. Next, a prospective pilot study is described to establish the relationship between cerebral ischemia and neurological complications using multimodal monitoring of cerebral perfusion. In the retrospective study, we found an incidence of PND of 42% in a cohort of 100 patients. PND patients had lower blood pressure levels and higher vasopressor dosages during the peri-operative period, however a low blood pressure was not found as independent risk factor in this study. The relation between blood pressure and cerebral perfusion is complex and even more complicated during surgical procedures requiring CPB with periods of CA and ACP. As a next step, we used a multimodal approach to establish individual differences in cerebral autoregulation, cerebral blood flow and cerebral oxygenation. In the prospective study, we have showed that our measurement set up is suitable for multimodal measurements regarding cerebral perfusion during the peri-operative period. As multiple advanced parameters influencing cerebral perfusion were considered, we were able to explore differences in more detail. In conclusion, with presented work, a next step is taken to identify causes of cerebral hypoperfusion in aortic arch surgery. In future, findings of individual differences in vulnerability for hypoperfusion might lead to a more personalised approach improving cerebral perfusion and reducing neurological dysfunction in aortic arch surgery.
Item Type:Essay (Master)
Faculty:TNW: Science and Technology
Subject:44 medicine
Programme:Technical Medicine MSc (60033)
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