title: Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care.
abstract: OBJECTIVE
  The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP).
  
  
  METHODS
  Retrospective and observational.
  
  
  METHODS
  Cardiothoracic operating rooms and intensive care unit.
  
  
  METHODS
  Seventy-nine consecutive adults undergoing elective proximal aortic arch repair with DHCA (1999-2001).
  
  
  METHODS
  None.
  
  
  RESULTS
  Average age of the patients was 64.9 years. Mean circulatory arrest time was 30.4 +/- 8.5 minutes. Perioperative mortality was 7.6%. Perioperative stroke incidence was 3.8%. Tracheal extubation was successful in 87.3% of patients within 24 hours of operation. Of the cohort, 80.8% were discharged from the intensive care unit within 72 hours of surgery. Median length of hospital stay was 7.4 days. Repeat mediastinal exploration because of bleeding occurred in 3.8% of patients. Although perioperative renal dysfunction (defined as >1.5-fold increase in plasma creatinine concentration) developed in 24.0% of patients, only 3.8% required dialysis.
  
  
  CONCLUSIONS
  The above parameters establish a baseline incidence for major perioperative complications in adults undergoing elective DHCA with RCP for elective proximal aortic arch repair. In approaching the open aortic arch for short periods of circulatory arrest, deep hypothermia with adjunctive RCP is safe and effective.
authors.affiliation: Department of Surgery, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA 19104-4283, USA.
authors.forename: Jehangir J
authors.initials: JJ
authors.lastname: Appoo
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Savino
authors.forename: Michael L
authors.initials: ML
authors.lastname: McGarvey
authors.forename: Doreen C
authors.initials: DC
authors.lastname: Cowie
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gambone
authors.forename: Hilary
authors.initials: H
authors.lastname: Harris
authors.forename: Albert T
authors.initials: AT
authors.lastname: Cheung
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology