[Aortic arch operation under deep hypothermic circulatory arrest].
OBJECTIVE
To summarize the surgical experience of aortic arch operation under deep hypothermic circulatory arrest.


METHODS
22 patients suffering from aortic dissection or descending aorta aneurysm with the involvement of aortic arch received operation under deep hypothermic circulatory arrest. Eight patients underwent ascending aorta and partial aortic arch replacement, one patient received aortic root, ascending aorta, and partial aortic arch replacement, 2 patients received ascending aorta and total arch replacement, 2 patients received aortic valve replacement plus ascending aorta and partial aortic arch replacement, 8 patients underwent ascending aorta and total arch replacement plus elephant trunk technique (stunted elephant trunk used in 6 cases), and 1 patient received left partial aortic arch and descending aorta replacement. Coronary artery bypass grafting was performed concomitantly in 4 cases.


RESULTS
Three patients died peri-operatively with a mortality rate of 13.6%. One patient had aortic dissection rupture before operation leading to cardiac tamponade, acute inferior myocardial infarction, and cardiac arrest. This patient received operation while resuscitation. After operation, the patient had severe right heart failure and died 16 hours later. One patient had bleeding and multi-organ failure, and died 3 days later. The third patient, with acute aortic dissection did not awake after operation, had pulmonary infection and multi-organ failure, and died 39 days later. Re-thoracotomy for bleeding was required in 3 cases; delayed awareness occurred in 3 cases; and 2 cases had renal failure after operation.


CONCLUSIONS
Aortic arch operation includes partial aortic arch replacement, total arch replacement, and total arch replacement with elephant trunk technique. The operation procedure is selected according to the primary lesion and how aortic arch has been affected. Deep hypothermic circulatory arrest with selective cerebral perfusion facilitates complicated aortic arch operation, resulting in a reduction of mortality and morbidity for arch aneurysms or dissection.
Wang
Li-Ming
LM
Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing 210006, China.
Chen
Xin
X
Shi
Kai-Hu
KH
Xu
Ming
M
Jiang
Ying-Shuo
YS
Xiao
Li-Qiong
LQ
Zhao
Hai-Peng
HP
Liu
Pei-Sheng
PS
Wang
Rui
R
Zhen
Ling
L
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged