title: Is there a need for adjunct cerebral protection in conjunction with deep hypothermic circulatory arrest during noncomplex hemiarch surgery?
abstract: OBJECTIVE
  Different cerebral protection strategies are currently being practiced during noncomplex hemiarch surgery without randomized control studies to show their relative efficacy. We hypothesized that deep hypothermic circulatory arrest (DHCA) alone was adequate for cerebral protection in noncomplex hemiarch surgery.
  
  
  METHODS
  Four hundred sixty-seven patients underwent noncomplex hemiarch surgery between January 2002 and December 2012. Calcified aortas and total arch surgeries were excluded. DHCA alone was used for 276 patients, DHCA with antegrade cerebral perfusion (ACP) was used for 114 patients, and DHCA with retrograde cerebral perfusion (RCP) was used for 77 patients.
  
  
  RESULTS
  Preoperative characteristics were similar between groups (12.3% in the DHCA group, 12.3% in the ACP group, and 10.3% in RCP group were reoperations). Patients in the DHCA group had shorter cardiopulmonary bypass times (193 minutes vs 217 minutes; P ≤ .005) and total lower body ischemic times (21 minutes vs 30 minutes; P ≤ .001) than ACP, but not RCP. Rates of reoperations for bleeding, postoperative stroke, and new renal failure did not differ between groups. New onset of cerebrovascular events were seen in 5.4% of patients in the DHCA group versus 6.2% of patients in the ACP group and 6.4% of patients in the RCP group (all P values > .7). Operative mortality in the DHCA group was 4.7% versus 2.6% in the ACP group and 2.6% in the RCP group (all P values > .4). Cox proportional hazard modeling showed no survival differences between groups.
  
  
  CONCLUSIONS
  Outcomes and survival using DHCA alone were comparable to adjunct cerebral protection methods in patients undergoing noncomplex hemiarch surgery. DHCA alone is as safe as other adjunct complex cerebral protection techniques and simplifies operation without additional risk.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kaneko
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Sary F
authors.initials: SF
authors.lastname: Aranki
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Neely
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Farhang
authors.initials: F
authors.lastname: Yazdchi
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Siobhan
authors.initials: S
authors.lastname: McGurk
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Marzia
authors.initials: M
authors.lastname: Leacche
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Boston, Mass. Electronic address: pshekar@partners.org.
authors.forename: Prem S
authors.initials: PS
authors.lastname: Shekar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D001900:Boston; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality