Short Moderate Hypothermic Circulatory Arrest without Any Adjunctive Cerebral Protection for Surgical Repair of the Ascending Aorta Extending into the Proximal Aortic Arch: Is It Safe?

Authors

  • Hiroyuki Kamiya
  • Uwe Klima
  • Christian Hagl
  • Klaus Kallenbach
  • Malakh L. Shrestha
  • Nawid Khaladj
  • Antje Bog
  • Axel Haverich
  • Matthias Karck

DOI:

https://doi.org/10.1532/HSF98.20061032

Abstract

Introduction. We have been using only moderate hypothermic circulatory arrest (HCA) for patients with ascending aortic aneurysms extending into the proximal aortic arch if the distal anastomoses seem to be simple and easy. The aim of this study is to evaluate the early and midterm results of the use of moderate HCA without any adjunctive cerebral protection in such patients.

Methods. Between October 2000 and March 2005, 23 patients with an age range of 39 to 77 years (mean, 59.7 ± 12.2 years) received surgical repair of the ascending aorta extending into the proximal aortic arch using HCA without any adjunctive cerebral protection. Mean circulatory arrest time was 7.5 ± 2.0 minutes (range, 2-13 minutes), and mean core temperature at induction of the circulatory arrest was 26.7 ± 1.4°C (range, 24-30°C).

Results. Operative mortality was 4.3% (1/23) due to unknown cause after successful extubation. Temporary neurological dysfunction was observed in only 1 patient (4.3%), and no persistent neurologic event was observed in any of the patients. One patient died 3 months after the operation due to a mediastinitis. No other cardiac or neurologic event was observed in the 21 surviving patients.

Conclusion. Our results suggest that moderate HCA at 26°C to 28°C without any adjunctive cerebral protection within 10 minutes is safe in selected patients.

References

Coselli JS. 1997. Retrograde cerebral perfusion is an effective means of neural support during deep hypothermic circulatory arrest. Ann Thorac Surg 64:908-12.nDi Eusanio M, Wesselink RM, Morshuis WJ, Dossche KM, Schepens MA. 2003. Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: a retrospective comparative study. J Thorac Cardiovasc Surg 125:849-54.nHagl C, Ergin MA, Galla JD, et al. 2001. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg 121:1107-21.nHagl C, Khaladj N, Karck M, et al. 2003. Hypothermic circulatory arrest during ascending and aortic arch surgery: the theoretical impact of different cerebral perfusion techniques and other methods of cerebral protection. Eur J Cardiothorac Surg 24:371-8.nKazui T, Yamashita K, Washiyama N, et al. 2002. Usefulness of ante-grade selective cerebral perfusion during aortic arch operations. Ann Thorac Surg 74:S1806-9.nMcCullough JN, Zhang N, Reich DL, et al. 1999. Cerebral metabolic suppression during hypothermic circulatory arrest in humans. Ann Thorac Surg 67:1895-9.nOkita Y, Minatoya K, Tagusari O, Ando M, Nagatsuka K, Kitamura S. 2001. Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg 72:72-9.nReich DL, Uysal S, Ergin MA, Bodian CA, Hossain S, Griepp RB. 2001. Retrograde cerebral perfusion during thoracic aortic surgery and late neuropsychological dysfunction. Eur J Cardiothorac Surg 19:594-600.n

Published

2006-07-14

How to Cite

Kamiya, H., Klima, U., Hagl, C., Kallenbach, K., Shrestha, M. L., Khaladj, N., Bog, A., Haverich, A., & Karck, M. (2006). Short Moderate Hypothermic Circulatory Arrest without Any Adjunctive Cerebral Protection for Surgical Repair of the Ascending Aorta Extending into the Proximal Aortic Arch: Is It Safe?. The Heart Surgery Forum, 9(4), E759-E761. https://doi.org/10.1532/HSF98.20061032

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