Short moderate hypothermic circulatory arrest without any adjunctive cerebral protection for surgical repair of the ascending aorta extending into the proximal aortic arch: is it safe?
BACKGROUND
We have been using only moderate hypothermic circulatory arrest (HCA) for patients with ascending aortic aneurysms extending into the proximal aortic arch if the distal anastomoses seem to be simple and easy. The aim of this study is to evaluate the early and midterm results of the use of moderate HCA without any adjunctive cerebral protection in such patients.


METHODS
Between October 2000 and March 2005, 23 patients with an age range of 39 to 77 years (mean, 59.7 +/- 12.2 years) received surgical repair of the ascending aorta extending into the proximal aortic arch using HCA without any adjunctive cerebral protection. Mean circulatory arrest time was 7.5 +/- 2.0 minutes (range, 2-13 minutes), and mean core temperature at induction of the circulatory arrest was 26.7 +/- 1.4 degrees C (range, 24-30 degrees C).


RESULTS
Operative mortality was 4.3% (1/23) due to unknown cause after successful extubation. Temporary neurological dysfunction was observed in only 1 patient (4.3%), and no persistent neurologic event was observed in any of the patients. One patient died 3 months after the operation due to a mediastinitis. No other cardiac or neurologic event was observed in the 21 surviving patients.


CONCLUSIONS
Our results suggest that moderate HCA at 26 degrees C to 28 degrees C without any adjunctive cerebral protection within 10 minutes is safe in selected patients.
Kamiya
Hiroyuki
H
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. hkamiya88@yahoo.co.jp
Klima
Uwe
U
Hagl
Christian
C
Kallenbach
Klaus
K
Shrestha
Malakh L
ML
Khaladj
Nawid
N
Bog
Antje
A
Haverich
Axel
A
Karck
Matthias
M
D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome