The safety and usefulness of cool head-warm body perfusion in aortic surgery.
OBJECTIVE
To determine the safety and usefulness of antegrade hypothermic cerebral perfusion in conjunction with mild hypothermic (tepid) visceral perfusion (so-called cool head-warm body perfusion; CHWB) in aortic surgery; the clinical outcomes and perioperative data on this new technique were retrospectively analyzed.


METHODS
From January 1990 to March 1999, 59 patients underwent ascending aorta or aortic arch surgery using antegrade selective cerebral perfusion (SCP). Three perfusion techniques, differentiated by perfusion temperature, were used, those being deep hypothermia (DH; nasopharyngeal temperature of 20 degrees C, n=14), moderate hypothermia (MH; nasopharyngeal temperature of 28 degrees C, n=17) and CHWB (nasopharyngeal temperature of 25 degrees C and bladder temperature of 32 degrees C, n=28). Selection of the technique largely followed a chronological pattern, in this order: DH, MH and, more recently, CHWB. The three groups were retrospectively compared in terms of operative outcome, duration of cardiopulmonary bypass (CPB) and operation, and intraoperative blood loss.


RESULTS
The early (within 30 days after surgery) mortality/hospital mortality (including operative mortality) was 7.1/21.4, 5.9/11.8 and 3.6/7.1% in the DH, MH and CHWB groups, respectively. The rate of stroke was 7.1, 6.3 and 3.6% in the DH, MH and CHWB groups, respectively. No statistical difference was found in early or hospital mortality, or in the rate of stroke among the three groups. The CPB time, especially the time for rewarming, was significantly shorter in the CHWB than in the DH group. Likewise, the operation time, especially the time after CPB, was significantly shorter in the CHWB than in the DH and MH groups. Blood loss was significantly less in the CHWB than in the DH group.


CONCLUSIONS
Our data suggest that CHWB perfusion in aortic surgery is a safe and useful technique in shortening the operation time and reducing blood loss, but further prospective study is necessary.
Takano
H
H
Department of Cardiovascular Surgery, Osaka Police Hospital, 10-31 Kitayamacho, Tennoji-ku, 543-0035, Osaka, Japan. htakano@pop02.odn.ne.jp
Sakakibara
T
T
Matsuwaka
R
R
Hori
T
T
Sakagoshi
N
N
Shinohara
N
N
D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D001831:Body Temperature / Q000502:physiology; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000502:physiology; D012189:Retrospective Studies; D012449:Safety; D015996:Survival Rate; D001743:Urinary Bladder / Q000502:physiology