Fifteen years of surgery for acute type A aortic dissection in moderate-to-mild systemic hypothermia†.
OBJECTIVE
Surgery for acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurological morbidity and mortality. The following study investigates the clinical results after surgical treatment for acute type A aortic dissection using selective antegrade cerebral perfusion and moderate-to-mild systemic hypothermia (≥28 °C).


METHODS
Between January 2000 and January 2015, 453 consecutive patients underwent surgical treatment for acute type A aortic dissection at two aortic referral centres in Germany. Patient mean age was 67 ± 13 years, 298 patients (66%) were male. Selective unilateral or bilateral cerebral perfusion under moderate-to-mild systemic hypothermia was used in all patients. Ascending aortic replacement, hemiarch replacement and total arch replacement was performed in 9 patients (2%), 342 patients (75%) and 102 patients (23%), respectively. Clinical data were prospectively entered into the institutional databases. Mean late follow-up was 6 ± 3 years and was 98% complete.


RESULTS
Cardiopulmonary bypass time totalled 181 ± 68 min and the myocardial ischaemic time 107 ± 43 min. Mean duration of selective antegrade cerebral was 46 ± 23 min. Mean lowest core temperature amounted to 28.8 ± 0.6 °C. Unilateral cerebral perfusion was performed in 298 patients (66%) and bilateral in 155 patients (34%). Mean intensive care unit stay was 5 ± 7 days. We observed new postoperative permanent neurological deficits in 27 patients (6%) and transient neurological deficits in 31 patients (7%). Thirty-day mortality was 7% (n = 32). Overall survival rate at 5 years was 77 ± 6%.


CONCLUSIONS
Our data suggest that selective antegrade cerebral perfusion in combination with moderate-to-mild systemic hypothermia (≥28 °C) can be safely and reproducibly applied to surgery for acute type A aortic dissection and offers sufficient neurological and visceral organ protection.
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany andreaszierer@gmx.at.
Andreas
A
Zierer
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany.
Ali
A
El-Sayed Ahmad
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany.
Nestoras
N
Papadopoulos
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany.
Faisal
F
Detho
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany.
Petar
P
Risteski
Division of Thoracic and Cardiovascular Surgery, Johann-Wolfgang-Goethe University, Frankfurt/Main, Germany.
Anton
A
Moritz
Division of Thoracic and Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Anno
A
Diegeler
Division of Thoracic and Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Paul P
PP
Urbanski
D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
Cerebral protection; Great vessels