Hypothermic circulatory arrest using antegrade cerebral perfusion is safe for elective aortic arch surgery.
BACKGROUND
We hypothesized that hypothermic circulatory arrest (HCA) can be performed with a low operative risk and does not add to the morbidity in elective procedures.


METHODS
A total of 178 patients with a mean (± SD) age of 62 (± 10) years underwent HCA for elective aortic surgery from April 2008 to September 2011. Pre- and postoperative clinical data were collected prospectively.


RESULTS
Hemiarch replacement was performed in 97% patients. Mean logistic Euroscore I was 17% (± 15). HCA was performed at 26°C bilateral tympanic temperature. Mean HCA duration was 17 (±) min. Mean cross-clamp time was 106 (± 39) min. Overall 30-day mortality was 2% and stroke occurred in 4% of patients. Overall 6-month survival was 96%. Cox regression analysis for 6-month survival revealed four variables with significant influence: the logistic Euroscore I (p = 0.008), age (p = 0.04), cross-clamp time (p = 0.008), and reoperation for bleeding complications (p = 0.04).


CONCLUSIONS
HCA with open distal anastomosis for elective aortic repair can be performed with low operative mortality, even in the elderly, and seems not to add to the morbidity of the procedure.
Division of Cardiac Surgery, University Hospital, Basel, Switzerland.
Peter
P
Matt
Franziska
F
Albrecht
Florian
F
Rueter
Martin
M
Grapow
Hans
H
Pargger
Jens
J
Fassl
Oliver
O
Reuthebuch
Friedrich
F
Eckstein
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002560:Cerebrovascular Circulation; D016009:Chi-Square Distribution; D017558:Elective Surgical Procedures; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000401:mortality; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D061646:Operative Time; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome