Totally normothermic aortic arch replacement without circulatory arrest.
BACKGROUND
Various techniques have been proposed for cerebral protection during the surgical treatment of complex aortic disease. The authors propose a revisited strategy of normothermic replacement of the aortic arch to avoid limitations and complications of profound hypothermic circulatory arrest.


METHODS
From April 2000 to May 2006, 19 patients with an aneurysm of the aortic arch and 10 patients with an acute (7) or a chronic (3) aortic dissection underwent a totally normothermic, complete replacement of the aortic arch using three pumps: One pump ensured antegrade cerebral perfusion, at a flow rate adapted to obtain a pressure of 70 mmHg in the right radial artery, and required a selective cannulation of the supra-aortic vessels. A second pump ensured body perfusion at a flow rate adapted to obtain a pressure of 55 mmHg in the left femoral artery and was situated between the right femoral artery and the right atrium. A special balloon aortic occlusion catheter was placed in the descending thoracic aorta. A third pump ensured intermittent normothermic myocardial perfusion via the coronary venous sinus. The arch reconstruction was performed with no time limit.


RESULTS
There were two operative, in-hospital (6.8%) mortalities. All others patients were rapidly extubated, except one, with no neurological sequelae, and postoperative course was uneventful, without coagulopathy or hepato-renal impairment.


CONCLUSIONS
In the light of these results, a normothermic procedure is possible for arch surgery and may ensure a more physiological autoregulation of cerebral blood flow while maintaining body perfusion without high vascular resistances.
Touati
Gilles D
GD
Department of Cardiovascular Surgery, Centre Hospitalier et Universitaire d'Amiens, Hôpital Sud, 80054 Amiens Cedex 01, France. gtouati.hms@invivo.edu
Marticho
Paul
P
Farag
Moataz
M
Carmi
Doron
D
Szymanski
Catherine
C
Barry
Misbaou
M
Trojette
Faouzi
F
Caus
Thierry
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D005263:Femoral Artery / Q000601:surgery; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications; D017534:Radial Artery / Q000601:surgery; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods