Reasonable Hypothermic Circulatory Arrest (? 28°C) with Selective Antegrade Cerebral Perfusion for Whole Arch Alternative with Frozen Elephant Trunk Method.
Thorac Cardiovasc Surg. 2018 Apr 01;:
Authors: El-Sayed Ahmad A, Risteski P, Ay M, Papadopoulos N, Moritz A, Zierer A
OBJECTIVES: ?The optimum hypothermic degree throughout circulatory arrest in aortic arch surgical procedure stays controversial, notably in frozen elephant trunk (FET) procedures. We describe herein our expertise for complete arch substitute with FET approach beneath average systemic hypothermic circulatory arrest (? 28°C) throughout selective antegrade cerebral perfusion.
METHODS: ?Between January 2009 and January 2016, 38 consecutive sufferers underwent elective complete arch substitute for varied aortic arch pathologies with FET approach utilizing the E-vita Open hybrid prosthesis (Jotec GmbH, Hechingen, Germany). Selective unilateral or bilateral cerebral perfusion beneath average systemic hypothermic circulatory arrest (28.7°C?±?zero.5°C) was utilized in all sufferers. Minimally invasive complete arch substitute with FET by way of partial higher sternotomy was carried out in 15 sufferers (39%) and within the remaining 23 sufferers (61%) by way of full sternotomy. Imply late follow-up was three?±?2 years and was 98% full. Scientific knowledge had been prospectively entered into our institutional database.
RESULTS: ?Cardiopulmonary bypass time accounted for 198?±?58 minutes and the myocardial ischemic time 109?±?29 minutes. Selective antegrade cerebral perfusion time was 55?±?6 minutes. Decrease physique circulatory arrest time was 39?±?11 minutes. Unilateral cerebral perfusion was carried out in 31 sufferers (82%), and bilateral in 7 sufferers (18%). Intensive care unit keep was four?±?three days. Thirty-day mortality was 5% (n?=?2). Late survival at three years was 87?±?three%. Two sufferers (5%) required reexploration for bleeding. Sufferers had been discharged after a hospital size of keep of seven?±?2 days. Postoperative everlasting neurologic complication occurred in two sufferers (5%). Three sufferers (eight%) skilled a transient neurologic dysfunction. New transient renal substitute remedy was mandatory in three sufferers (eight%). No spinal wire harm was famous.
CONCLUSIONS: ?Our knowledge counsel that average systemic hypothermic circulatory arrest (? 28°C) together with antegrade cerebral perfusion can safely be utilized for complete aortic arch substitute with FET and gives adequate neurologic and visceral organ safety.
PMID: 29605960 [PubMed – as supplied by publisher]