title: Early and midterm outcomes of quick proximal arch replacement with mild hypothermia and rapid rewarming for type A acute aortic dissection.
abstract: OBJECTIVE
  We assessed the efficacy of our unique procedure with mild hypothermic circulatory arrest and rapid rewarming during emergency surgery for type A acute aortic dissection.
  
  
  METHODS
  During the last 6 years, 91 patients with acute aortic dissection and an average age of 66.2 ± 14.1 years underwent our newly modified quick hemiarch replacement. Eighteen patients (19.8%) had independent predictors for surgical mortality, such as preoperative cardiopulmonary arrest or malperfusion of vital organs. During open distal anastomosis with a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40°C, accompanied by warming of the patient's body using a heating mat. As soon as distal anastomosis was completed, rapid rewarming was initiated by 40°C blood perfusion.
  
  
  RESULTS
  Circulatory arrest, cardiopulmonary bypass, and overall operation times were 19.1 ± 5.1, 86.2 ± 17.8, and 150.1 ± 25.2 minutes, respectively. Five patients (5.5%) required reexploration for bleeding, and 4 patients (4.4%) had strokes, but none had acute renal failure. The hospital mortality rate was 3.3% (3 patients), and the postoperative hospital stay was 10.6 ± 4.7 days. Five patients required replacement of the distal arch or descending aorta at a later stage. Eight patients died during follow-up. A postoperative midterm computed tomography scan revealed a closed distal arch in more than 80% of patients and partial abdominal open false lumen in 45% of patients. Echocardiograms showed mild aortic valve regurgitation in 8 patients. The freedom from reoperation rate at 5 years was 90.0%. Actuarial survival including operative death was 82.7% at 5 years.
  
  
  CONCLUSIONS
  Our original technique is a safe and less-invasive procedure that enables a quicker surgery. The midterm outcome also was favorable.
authors: Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. hata.mitsumasa@nihon-u.ac.jp
authors: Mitsumasa
authors: M
authors: Hata
authors: Kenji
authors: K
authors: Akiyama
authors: Hiroaki
authors: H
authors: Hata
authors: Akira
authors: A
authors: Sezai
authors: Isamu
authors: I
authors: Yoshitake
authors: Shinji
authors: S
authors: Wakui
authors: Motomi
authors: M
authors: Shiono
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001018:Aortic Diseases / Q000145:classification / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods; D008297:Male; D008875:Middle Aged; D017694:Rewarming / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome