title: Effects of intermittent lower body perfusion on end-organ function during repair of acute DeBakey type I aortic dissection under moderate hypothermic circulatory arrest.
abstract: OBJECTIVE
  To avoid deep hypothermia-related side effects, moderate hypothermic circulatory arrest (HCA) is commonly employed during aortic arch repair, thereby jeopardizing end-organ protection. We sought to analyse the effect of intermittent lower body perfusion (ILBP) on end-organ function during repair of acute DeBakey type I aortic dissection (AIAD).
  
  
  METHODS
  Between May 2008 and May 2011, 107 patients underwent surgical repair for AIAD. All operations were performed with selective cerebral perfusion (SCP) under either moderate HCA only (n = 57) or moderate HCA with ILBP (n = 50). Adverse outcomes, including operative mortality, permanent neurological deficit, temporary neurological deficit, renal failure requiring dialysis and hepatic dysfunction, were compared between the two groups.
  
  
  RESULTS
  The mean body temperature at the initiation of SCP was 28.7 ± 1.9 °C. Overall operative mortality occurred in 6 (5.6%) patients. The incidences of permanent neurological deficit and temporary neurological deficit were 1.9 and 4.7%, respectively. None of the 9 (8.4%) patients who suffered postoperative renal failure requiring dialysis received ILBP. The laboratory data showed significantly lower levels of hepatic and kidney enzymes in the ILBP group (P < 0.05).
  
  
  CONCLUSIONS
  Significantly lower levels of hepatic and kidney enzymes indicate more effective end-organ protection with the use of ILBP. Our data suggest that ILBP provides more effective end-organ protection during repair of aortic arch under moderate HCA.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Suk-Won
authors.initials: SW
authors.lastname: Song
authors.forename: Kyung-Jong
authors.initials: KJ
authors.lastname: Yoo
authors.forename: Yoo Rim
authors.initials: YR
authors.lastname: Shin
authors.forename: Sun-Hee
authors.initials: SH
authors.lastname: Lim
authors.forename: Bum-Koo
authors.initials: BK
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D015424:Reperfusion / Q000009:adverse effects / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aortic dissection; Circulatory arrest