Less invasive quick replacement for octogenarians with type A acute aortic dissection.
OBJECTIVE
We assessed the efficacy of our newly modified technique, namely, less invasive quick replacement with rapid rewarming, for octogenarians undergoing emergency surgery for type A acute aortic dissection.


METHODS
Forty-two patients with acute aortic dissection, whose average age was 81.7 +/- 2.3 years, were divided into two groups: group I consisted of 25 patients undergoing surgery with deep hypothermic circulatory arrest and selective cerebral perfusion; group II consisted of 17 recent patients who underwent less invasive quick replacement. In the latter technique, during open distal anastomosis with a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40 degrees C accompanied by warming of the patient's body by a heating mat. As soon as the distal anastomosis was completed, rapid rewarming was initiated by 40 degrees C blood perfusion.


RESULTS
The durations of cerebral protection (group I, 75.8 minutes, vs group II, 18.8 minutes), cardiopulmonary bypass (I, 201.2, vs II, 84.4 minutes), and overall operation (I, 425.6, vs II, 148.6 minutes) were significantly shorter in group II. In group I, 5 patients had complications of cerebral damage and 5 required re-exploration for bleeding, 7 had pneumonia, 6 required hemodialysis for renal failure, and the hospital mortality rate was 24% (6 patients). On the other hand, no such complications or mortality were observed in group II (P < .0291). Postoperative hospital stay was significantly shorter for the patients in group II than in group I (13.2 days vs 33.7 days; P < .0001).


CONCLUSIONS
Less invasive quick replacement is safe and effective. It should be a standard surgical technique for octogenarians with type A acute aortic dissection.
Hata
Mitsumasa
M
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. mihata@med.mihon-u.ac.jp
Suzuki
Mitsunori
M
Sezai
Akira
A
Niino
Tetsuya
T
Unosawa
Satoshi
S
Furukawa
Nobuyuki
N
Minami
Kazutomo
K
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass / Q000379:methods; D004630:Emergencies; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D017694:Rewarming