[The treatment of acute dissections of the aorta by circulatory arrest under deep hypothermia and retrograde cerebral perfusion].
The use of profound hypothermia with retrograde cerebral perfusion was described by Ueda in 1988. The innovation of this technique was the retrograde perfusion of oxygenated blood at a temperature of 15 degrees C and a pressure of 25 mmHg via the superior vena cava during the circulatory arrest period. Between february 1993 and march 1994, this technique was used in 12 patients in our department, with acute dissection of the aorta present in 8 cases. In this series of 8 patients, 3 females and 5 males aged 47 to 73 (mean age 60 years)--there were 7 type I acute dissections, one of which occurred on an annulo-aortic ectasia, and 1 type III retrograde dissection with hemopericardium. Treatment consisted of 7 supracoronary tubes one of which extended as a tongue along the inner curvature of the aortic arch, and 1 Cabrol's procedure. Mean times were: extracorporeal circulation: 148 +/- 50 minutes, core cooling: 60 +/- 20 min., circulatory arrest: 34 +/- 9 min., core rewarming: 69 +/- 27 min. Average flow of retrograde perfusion was 440 +/- 350 ml/minute. Mean post operative bleeding was 650 +/- 150 ml for the first 48 hours. No patient awoke with signs of neurological deficiency. Seven patients were weaned from mechanical ventilation either on day 1 or day 2. They presented normal neurological examination. One patient in whom minor post operative disturbance postponed mechanical ventilation weaning to day 4, was neurologically intact upon examination prior to hospital discharge. One patient with no initial post operative complication, died of thrombosis of the Cabrol prosthesis at day 8.(ABSTRACT TRUNCATED AT 250 WORDS)
Chocron
S
S
Service de Chirurgie Thoracique et Cardio-vasculaire, Hôpital Saint-Jacques, Besançon.
Taberlet
C
C
Clement
F
F
Alwan
K
K
Schipman
N
N
Etievent
J P
JP
D000784:Aortic Dissection / Q000601:surgery / Q000628:therapy*; D001014:Aortic Aneurysm / Q000601:surgery / Q000628:therapy*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002548:Cerebral Revascularization / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation
Le traitement des dissections aiguës de l'aorte en arrêt circulatoire sous hypothermie profonde et rétroperfusion cérébrale.