Effects of hypothermic arrest circulation with moderate or deep hypothermic antegrade selective cerebral perfusion technique in patients undergoing total aortic replacement
10.3760/cma.j.issn.1001-4497.2011.07.015
- VernacularTitle:胸主动脉瘤手术中中浅低温停循环加顺行性脑灌注技术的应用
- Author:
Hong NI
;
Xiaotong HOU
- Publication Type:Journal Article
- Keywords:
Aortic aneurysm;
Cardiopulmonary bypass;
Cerebral protection
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2011;27(7):423-425
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the effects of hypothermic arrest circulation ( HAC) with moderate or deep hypothermic antegrade selective cerebral perfusion ( ASCP) technique in patients with DeBake type Ⅰ aortic dissection or aortic arch aneurysm undergoing total aortic arch replacement. Methods Between Feb. 2007 and Aug. 2009, 60 patients who underwent aortic arch replacement using HAC + SCP technique. Patients were divided into two groups according to the lowest nasopharyngeal temperature: moderate hypothermia (18 - 20℃) (group MH, n = 28), and deep hypothermia (23 -25 ℃) (group DH,n=32). The clinical and neurological outcomes were observed. Results The overall in-hospital mortality was 3. 33% (2/60) ; In-hospital mortality was 3. 6% in the MH group, while3.1% in the DH group. There were no significant differences regarding to preoperative the patients' character parameters in both groups. At the beginning of ASCP, the nasopharyngeal and rectal temperatures were significantly higher in group MH[MH group (23.8 ± 1. 9 ) ℃ ( 26. 6 ± 2. 4 ) ℃ vs. DH group group (29.4 ±9.3) min vs. DH group(32.9 ± 13.4) min]. The rewarming time and CPB time were significantly shorter in MH group[(65.0±13.9) min vs. (90.3 ±27.2) min; (142.8 ±34.2) min vs. (194.1 ±42.0) min, P <0. 05]. Temporary neurologic deficits occurred in four patients (6. 67% ) without significant differences between two groups ( MH group 7.14% vs. DH group 6. 25% ). No patient suffered from permanent neurologic dysfunction. There were no significant differences between two groups in other parameters including intubation time, kidney insufficiency, the stay times in ICU and hospital. Conclusion Our results demonstrate that moderate HCA + ASCP technique is a safe strategy for the treatment of patients who require conventional total arch replacement with individual arch-vessel reconstruction. Shorter CPB time in patients with moderate HCA + ASCP did not increase any other postoperative adverse effects.
