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.
Published
How to Cite
Issue
Section
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).