Quick proximal arch replacement with moderate hypothermic circulatory arrest.
BACKGROUND
The aim of this study is to evaluate the safety of proximal arch repair using only moderate hypothermic circulatory arrest (HCA) at a temperature of 25 degrees C to 28 degrees C without any adjunctive cerebral protection in comparison with those with moderate HCA and selective cerebral perfusion.


METHODS
Thirty patients who underwent proximal arch repair using moderate HCA without selective cerebral perfusion (SCP) were retrospectively examined and defined as the SCP (-) group. As a control group, 31 patients who underwent moderate HCA and SCP within 10 minutes were included in this study and defined as the SCP (+) group.


RESULTS
Mean circulatory arrest time was 9.4 +/- 0.8 minutes and 7.5 +/- 1.8 minutes (p = 0.0001) and mean nasopharyngeal temperature at the induction of the circulatory arrest was 26.0 +/- 1.2 degrees C and 26.8 +/- 1.3 degrees C (p = 0.014) in the SCP (+) group and SCP (-) group, respectively. Operative mortality was 3.2% in the SCP (+) group and 3.3% in the SCP (-), and neurologic complications were found in three (9.7%) patients in the SCP (+) group and two (6.7%) patients in the SCP (-) group (p = 0.69).


CONCLUSIONS
It was possible to perform proximal arch replacement in selected patients using moderate HCA without any adjunctive cerebral protection with excellent results, and no advantage of the use of SCP was found in patients who required short HCA for proximal arch replacement.
Kamiya
Hiroyuki
H
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany. hiroyuki.kamiya@med.uni-heidelberg.de
Hagl
Christian
C
Kropivnitskaya
Irina
I
Weidemann
Juergen
J
Kallenbach
Klaus
K
Khaladj
Nawid
N
Haverich
Axel
A
Karck
Matthias
M
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D001831:Body Temperature; D001921:Brain / Q000098:blood supply; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009305:Nasopharynx / Q000503:physiopathology; D009422:Nervous System Diseases / Q000209:etiology; D010477:Perfusion / Q000379:methods; D012189:Retrospective Studies; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality