Safety of mild hypothermic circulatory arrest with selective cerebral perfusion.
Although hypothermic circulatory arrest with antegrade selective cerebral perfusion is used for cerebral protection, optimal perfusion characteristics are still unclear. Between May 2006 and March 2008, 26 patients (mean age, 68.9 years; 14 males) underwent thoracic aortic repair with mild hypothermic circulatory arrest (34.3 degrees C +/- 1.9 degrees C) and antegrade selective cerebral perfusion (30 degrees C) for various indications including 16 acute type A aortic dissections. Mean cerebral perfusion rate was 21.1 +/- 4.3mL kg(-1) min(-1). Non-elective operations were carried out in 16 (61.5%) cases. Operative procedures were ascending aortic replacement in 16 patients, hemiarch replacement in 4, and total arch replacement in 6. Cardiopulmonary bypass time was 209 +/- 61 min, cardiac ischemic time was 141 +/- 45 min, cerebral perfusion time was 81 +/- 67 min, and lower body circulatory arrest time was 65 +/- 22 min. Mean rectal temperature drifted to 30.6 degrees C +/- 1.3 degrees C. There was 1 (3.8%) hospital death due to rupture of a residual descending thoracic aneurysm. One patient needed reexploration for bleeding, and 2 (7.7%) suffered permanent neurologic dysfunction. No postoperative spinal cord dysfunction was observed. Mild hypothermic circulatory arrest with antegrade selective cerebral perfusion could be performed safely in our patient population.
Toyama
Masashi
M
Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, 2-20-37 Shibata, Yokkaichi 510-8567, Japan. machapon@tg.commufa.jp
Matsumura
Yasumoto
Y
Tamenishi
Akinori
A
Okamoto
Hiroshi
H
D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome