Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery.
OBJECTIVE
Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24-28 degrees C) or deep hypothermia (18-24 degrees C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28-32 degrees C).


METHODS
Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP.


RESULTS
Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay.


CONCLUSIONS
Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.
Kaneda
Toshio
T
Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada City, Osaka, Japan. toshio_kaneda@hotmail.com
Saga
Toshihiko
T
Onoe
Masahiko
M
Kitayama
Hitoshi
H
Nakamoto
Susumu
S
Matsumoto
Terufumi
T
Inoue
Takehiro
T
Imura
Masato
M
Ogawa
Tatsuya
T
Nishino
Takako
T
Fujii
Kousuke
K
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007431:Intraoperative Complications / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*