title: Antegrade selective cerebral perfusion with mild hypothermic systemic circulatory arrest during thoracic aortic surgery.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, Kishiwada City Hospital, Kishiwada City, Osaka, Japan. toshio_kaneda@hotmail.com
authors.forename: Toshio
authors.initials: T
authors.lastname: Kaneda
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Saga
authors.forename: Masahiko
authors.initials: M
authors.lastname: Onoe
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Kitayama
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakamoto
authors.forename: Terufumi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Takehiro
authors.initials: T
authors.lastname: Inoue
authors.forename: Masato
authors.initials: M
authors.lastname: Imura
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Ogawa
authors.forename: Takako
authors.initials: T
authors.lastname: Nishino
authors.forename: Kousuke
authors.initials: K
authors.lastname: Fujii
mesh_terms: 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*