title: Moderate versus deep hypothermic circulatory arrest for elective aortic transverse hemiarch reconstruction.
abstract: BACKGROUND
  Deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (DHCA group) has traditionally been the cerebral protection strategy during transverse hemiarch aortic reconstruction. Recently, we have adopted moderate hypothermic (≥ 25 °C) circulatory arrest (MHCA) with antegrade cerebral perfusion (MHCA group). We compared the outcomes for these two circulatory arrest management strategies.
  
  
  METHODS
  From 2008 to 2012, in a concurrent series of 376 patients (DHCA, 301; MHCA, 75) undergoing transverse hemiarch for aortic aneurysm disease, incidences of concomitant root replacement (44% vs 47%, p = 0.8), and aortic valve replacement (29% vs 21%, p = 0.3) were similar, although atherosclerotic aneurysm pathology was present in patients in the MHCA group (71% vs 33%, p < 0.01). Antegrade cerebral perfusion was established via axillary artery or direct innominate artery cannulation. A database was prospectively maintained.
  
  
  RESULTS
  MHCA group patients were older (66 ± 11 vs 60 ± 14 years; p < 0.01). Other demographics were similar. Aortic cross-clamp (128 ± 46 vs 163 ± 57 minutes, p < 0.01) and cardiopulmonary bypass (167 ± 49 vs 222 ± 61 minutes, p < 0.01) times were lower in the MHCA group. Transfusion requirements were significantly reduced with MHCA (38% vs 61%, p < 0.01), especially use of fresh frozen plasma and cryoprecipitate. Direct innominate artery cannulation did not result in any vascular or neurologic complication. Postoperative outcomes were similar. In-hospital and 30-day mortality was 1% in both groups. Stroke (0% vs 2%) and hemodialysis rates (0% vs 1%) were also similar.
  
  
  CONCLUSIONS
  MHCA with antegrade cerebral perfusion yields excellent and equivalent outcomes to DHCA for elective aortic hemiarch reconstruction. MHCA significantly improves intraoperative times and, importantly, reduces transfusion requirements compared with DHCA with a retrograde cerebral perfusion strategy.
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Vallabhajosyula
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Arminder S
authors.initials: AS
authors.lastname: Jassar
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Rohan S
authors.initials: RS
authors.lastname: Menon
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Caroline
authors.initials: C
authors.lastname: Komlo
authors.affiliation: Department of Anesthesia, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jacob
authors.initials: J
authors.lastname: Gutsche
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Nimesh D
authors.initials: ND
authors.lastname: Desai
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: W Clark
authors.initials: WC
authors.lastname: Hargrove
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.affiliation: Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: wilson.szeto@uphs.upenn.edu.
authors.forename: Wilson Y
authors.initials: WY
authors.lastname: Szeto
mesh_terms: D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D016896:Treatment Outcome