Mild Hypothermic Circulatory Arrest with Lower Body Perfusion for Total Arch Replacement Via Upper Hemisternotomy in Acute Type A Dissection
DOI:
https://doi.org/10.1532/hsf.3729Keywords:
Minimally invasive cardiac surgery, total arch replacement, lower body perfusion, mild hypothermia circulatory arrestAbstract
Background: Mild hypothermia circulatory arrest combined with lower body perfusion (LBP) might be beneficial for the recovery of patients with acute type A dissection. However, the safety of mild hypothermic circulatory arrest with LBP used in total arch replacement combined with frozen elephant trunk implantation (FET) via single upper hemisternotomy approach is ambiguous.
Methods: We retrospectively analyzed 70 consecutive patients with acute type A dissections who underwent total arch replacement combined with FET between April 2019 to December 2019. These individuals were divided into the moderate (MO) group (N = 39, surgery performed at moderate hypothermic circulatory arrest) and the mild (MI) group (N = 31, surgery conducted at mild hypothermic circulatory arrest with LBP). Perioperative characteristics were recorded.
Results: No significant difference in any of the pre- and intraoperative variables was observed between the two groups except for circulatory arrest time, which was significantly shorter in the MI group compared with the MO group [10 (8-11) min vs. 35 (31- 34) min, P = 0.000]. After operation, ventilation times [19 (16 - 24) h vs. 24 (17 - 43) h, P = 0.046] and ICU stay [41 (34 - 58) h vs. 54 (42 - 85) h, P = 0.002] were significantly shorter in the MI group compared with the MO group.
Conclusions: Total arch replacement combined with FET at mild hypothermia circulatory arrest with lower body antegrade perfusion via single upper hemisternotomy approach is safe and feasible with significantly shorter time of circulatory arrest compared with no LBP.
References
Algarni KD, Yanagawa B, Rao V, Yau TM. 2014. Profound hypothermia compared with moderate hypothermia in repair of acute type A aortic dissection. The Journal of Thoracic and Cardiovascular Surgery. 148(6):2888-94.
Angeloni E, Melina G, Refice SK, Roscitano A, Capuano F, Comito C, et al. 2015. Unilateral Versus Bilateral Antegrade Cerebral Protection During Aortic Surgery: An Updated Meta-Analysis. The Annals of Thoracic Surgery. 99(6):2024-31.
Ariyaratnam P, Loubani M, Griffin SC. 2015. Minimally invasive aortic valve replacement: Comparison of long-term outcomes. Asian Cardiovascular and Thoracic Annals. 23(7):814-21.
Candaele S, Herijgers P, Demeyere R, Flameng W, Evers G. 2003. Chest pain after partial upper versus complete sternotomy for aortic valve surgery. ACTA CARDIOL. 58(1):17-21.
Guo J, Wang Y, Zhu J, Cao J, Chen Z, Li Z, et al. 2014. Right axillary and femoral artery perfusion with mild hypothermia for aortic arch replacement. J CARDIOTHORAC SURG. 9(1):94.
Jiang H, Liu Y, Yang Z, Ge Y, Li L, Wang H. 2020. Total arch replacement via single upper hemisternotomy approach in patients with Type A dissection. The Annals of Thoracic Surgery. 109(5):1394-1399.
Jonsson O, Morell A, Zemgulis V, Lundstrom E, Tovedal T, Einarsson GM, et al. 2011. Minimal safe arterial blood flow during selective antegrade cerebral perfusion at 20 degrees centigrade. ANN THORAC SURG. 91(4):1198-205.
Li B, Hu X, Wang Z. 2017. The neurologic protection of unilateral versus bilateral antegrade cerebral perfusion in aortic arch surgery with deep hypothermic circulatory arrest: A study of 77 cases. INT J SURG. 40:8-13.
Lin J, Xiong J, Luo M, Tan Z, Wu Z, Guo Y, et al. 2019. Combining Cerebral Perfusion With Retrograde Inferior Vena Caval Perfusion for Aortic Arch Surgery. The Annals of Thoracic Surgery. 107(1):e67-9.
Liu Z, Sun L, Chang Q, Zhu J, Dong C, Yu C, et al. 2006. Should the “elephant trunk” be skeletonized? Total arch replacement combined with stented elephant trunk implantation for Stanford type A aortic dissection. The Journal of Thoracic and Cardiovascular Surgery. 131(1):107-13.
Nappi G, Maresca L, Torella M, Cotrufo M. 2007. Body perfusion in surgery of the aortic arch. Tex Heart Inst J. 34(1):23-9.
Numata S, Tsutsumi Y, Monta O, Yamazaki S, Seo H, Sugita R, et al. 2012. Aortic arch repair with antegrade selective cerebral perfusion using mild to moderate hypothermia of more than 28 degrees C. ANN THORAC SURG. 94(1):90-5, 95-6.
Shrestha M, Bachet J, Bavaria J, Carrel TP, De Paulis R, Di Bartolomeo R, et al. 2015. Current status and recommendations for use of the frozen elephant trunk technique: a position paper by the Vascular Domain of EACTS. EUR J CARDIO-THORAC. 47(5):759-69.
Spielvogel D, Kai M, Tang GH, Malekan R, Lansman SL. 2013. Selective cerebral perfusion: a review of the evidence. J Thorac Cardiovasc Surg. 145(3 Suppl):S59-62.
Sun LM, Qi RM, Chang QM, Zhu JM, Liu YM, Yu CM, et al. 2009. Is total arch replacement combined with stented elephant trunk implantation justified for patients with chronic Stanford type A aortic dissection? The Journal of Thoracic and Cardiovascular Surgery. 138(4):892-6.
Takayama HMP, Borger MAMP. 2017. Bilateral antegrade cerebral perfusion during aortic dissection surgery: If no harm, then why not? Journal of Thoracic and Cardiovascular Surgery, The. 154(3):776-7.
Toyama M, Matsumura Y, Tamenishi A, Okamoto H. 2009. Safety of mild hypothermic circulatory arrest with selective cerebral perfusion. Asian Cardiovasc Thorac Ann. 17(5):500-4.
Urbanski PP, Lenos A, Bougioukakis P, Neophytou I, Zacher M, Diegeler A. 2012. Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm? Eur J Cardiothorac Surg. 41(1):185-91.
Zierer A, Detho F, Dzemali O, Aybek T, Moritz A, Bakhtiary F. 2011. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. ANN THORAC SURG. 91(6):1868-73.
