Outcome of less invasive proximal arch replacement with moderate hypothermic circulatory arrest followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection.
BACKGROUND
The mid-term outcome of quick proximal arch replacement with moderate hypothermia followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection (AAD) was assessed.


RESULTS
Eighty-five patients were divided into 2 groups: group I consisted of 43 patients undergoing surgery for deep hypothermic circulatory arrest and selective cerebral perfusion; and group II consisted of 42 patients who recently underwent aggressive rapid re-warming. During open distal anastomosis in group II patients with a rectal temperature of 28 degrees C but who did not suffer any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed to 40 degrees C. As soon as distal anastomosis was completed, rapid re-warming was initiated by a 40 degrees C blood perfusion. The duration of CPB (I: 182.1 vs II: 85.3 min), overall operation (305.0 vs 150.8 min), postoperative mechanical ventilation (44.3 vs 9.1 h), and hospital stay (31.4 vs 9.6 days) were significantly shorter in group II patients. The incidence of postoperative brain complication (I: 14.0 vs II: 2.4%), renal failure (14.0 vs 0%), pneumonia (18.6 vs 4.8%), and mortality (9.3 vs 0%) was significantly less in group II patients.


CONCLUSIONS
Moderate hypothermia followed by a rapid re-warming procedure was safe and effective in the proximal arch replacement for AAD.
Hata
Mitsumasa
M
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. mihata@med.nihon-u.ne.jp
Suzuki
Mitsunori
M
Sezai
Akira
A
Niino
Tetsuya
T
Yoshitake
Isamu
I
Unosawa
Satoshi
S
Shimura
Kazuma
K
Minami
Kazutomo
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D017694:Rewarming / Q000009:adverse effects; D016896:Treatment Outcome