title: Aortic arch surgery using moderate hypothermia and unilateral selective antegrade cerebral perfusion.
abstract: BACKGROUND
  Cerebral protection and circulatory management remains a controversial issue in aortic arch surgery. The present study reported surgical outcomes of arch repair using moderate hypothermic circulatory arrest (MHCA) and unilateral selective antegrade perfusion (uSACP).
  
  
  METHODS
  From January 2004 and December 2012, 500 patients underwent hemiarch repair (HARCH) and 124 underwent total arch replacement (TARCH) utilizing moderate hypothermic circulatory arrest with unilateral selective antegrade cerebral perfusion of the right axillary artery. Emergent surgery was required in 142 (28.4%) of HARCH patients and 18 (14.5%) of TARCH patients. Mean arrest temperature ranged from 25.6-27.2 °C for elective and emergent operations in both groups. Mean circulatory arrest was 26.8 minutes for hemiarch repairs and 54.2 minutes for total arch replacement.
  
  
  RESULTS
  Overall mortality was 6.6% for hemiarch repairs and 9.7% for total arch replacements. Hospital mortality was 4.5% (16/358) and 10.4% (11/106) in elective cases, and 12% (17/142) and 5.6% (1/18) in elective cases, for hemiarch and total arch replacements respectively. Permanent neurological deficit (PND) occurred in 3 total arch replacement cases (2.4%). Multivariate analysis demonstrated that temperature was not found to be an independent risk factor during hemiarch or total arch replacements for mortality, permanent or neurological deficits, or renal failure.
  
  
  CONCLUSIONS
  Our approach for hemiarch and total arch repair utilizing MHCA and uSACP via the right axillary artery was associated excellent neurological and survival outcomes. Moderate hypothermia did not adversely impact cerebral or visceral organ protection.
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors: Bradley G
authors: BG
authors: Leshnower
authors: Richard J
authors: RJ
authors: Myung
authors: Edward P
authors: EP
authors: Chen
keywords: Aortic arch surgery; hemiarch repair; moderate hypothermic circulatory arrest; retrospective study; total arch replacement
references: Eur J Cardiothorac Surg. 2008 Oct;34(4):792-6; disussion 796
references: 18579405
references: Ann Thorac Surg. 2010 Aug;90(2):547-54
references: 20667348
references: Ann Thorac Surg. 1992 Jan;53(1):109-14
references: 1530810
references: Circulation. 2008 Sep 30;118(14 Suppl):S160-6
references: 18824749
references: J Card Surg. 1997 Mar-Apr;12(2 Suppl):322-5
references: 9271762
references: Ann Thorac Surg. 1999 Jun;67(6):1887-90; discussion 1891-4
references: 10391333
references: Ann Thorac Surg. 2010 May;89(5):1448-57
references: 20417760
references: Ann Thorac Surg. 2001 Nov;72(5):1457-64
references: 11722026
references: Ann Thorac Surg. 2012 Jun;93(6):1910-5; discussion 1915-6
references: 22560963
references: J Thorac Cardiovasc Surg. 1994 Mar;107(3):788-97; discussion 797-9
references: 8127108
references: J Thorac Cardiovasc Surg. 2012 Nov;144(5):1042-49
references: 22967770
references: J Thorac Cardiovasc Surg. 2007 Feb;133(2):501-9
references: 17258589
references: Ann Thorac Surg. 2004 Oct;78(4):1274-84; discussion 1274-84
references: 15464485
references: Ann Surg. 2001 Sep;234(3):336-42; discussion 342-3
references: 11524586
references: J Thorac Cardiovasc Surg. 1975 Dec;70(6):1051-63
references: 1186283
references: Ann Thorac Surg. 1995 Aug;60(2):319-27; discussion 327-8
references: 7646092
references: J Thorac Cardiovasc Surg. 1991 Jul;102(1):85-93; discussion 93-4
references: 2072732
references: J Card Surg. 1994 Sep;9(5):525-37
references: 7994095
references: J Thorac Cardiovasc Surg. 2001 Aug;122(2):331-8
references: 11479507
references: J Cardiothorac Vasc Anesth. 2006 Oct;20(5):673-7
references: 17023287
references: Ann Thorac Surg. 2001 Jul;72(1):72-9
references: 11465234
references: Ann Thorac Surg. 2000 Mar;69(3):696-702; discussion 703
references: 10750746
references: J Thorac Cardiovasc Surg. 1997 Oct;114(4):660-5
references: 9338653
references: J Thorac Cardiovasc Surg. 2001 Jun;121(6):1107-21
references: 11385378
references: Circulation. 2001 Sep 18;104(12 Suppl 1):I276-81
references: 11568069