Early- and mid-term results of emergent aortic arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion

BAO Chunrong; MEI Ju; DING Fangbao; ZHU Jiaquan; ZHANG Junwen; ZHANG Yunjiao; HUANG Jianbin; ZHANG Li; YANG Qi

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Early- and mid-term results of emergent aortic arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion

VernacularTitle:应用中低温停循环联合单侧脑灌注行急诊弓部置换手术的早中期结果
Author: BAO Chunrong ¹ ; MEI Ju ¹ ; DING Fangbao ¹ ; ZHU Jiaquan ¹ ; ZHANG Junwen ¹ ; ZHANG Yunjiao ¹ ; HUANG Jianbin ¹ ; ZHANG Li ¹ ; YANG Qi ¹
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1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200092, P.R.China
Publication Type:Journal Article
Keywords: Aortic arch replacement; hypothermic circulatory arrest; antegrade cerebral perfusion
From: Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2019;26(8):754-758
CountryChina
Language:Chinese
Abstract: Objective To investigate the results of emergent aortic arch replacement using moderate hypothermic circulatory arrest and unilateral antegrade cerebral perfusion (MHCA+UACP). Methods We retrospectively analyzed the clinical data of 146 patients who underwent emergent aortic arch replacement using MHCA+UACP in our institution from January 2008 to June 2018. There were 111 males and 35 females aged 60.3±7.2 years. According to different surgical approaches, patients were divided into two groups: a total arch replacement (TAR) group (n=104) and a semi arch replacement (SAR) group (n=42). Right axillary artery was cannulated for cardiopulmonary bypass (CPB) and cerebral perfusion. Core temperature at the onset of MHCA was 23.4±1.4 ℃. UACP was initiated at 18-22 ℃ with the flow of 5-10 ml/(kg·min). Flow was adjusted to maintain cerebral perfusion pressure of 50–60 mm Hg. Results CPB time was 235.0±42.0 min. Aortic clamp time was 154.0±29.0 min. Circulatory arrest (CA) time was 48.1±13.0 min. The CPB time and CA time of the TAR group were longer than those of SAR group. Overall mortality rate was 9.6%. Complications included permanent neurological dysfunction (PND), temporary neurological dysfunction (TND), acute kidney injury (AKI) requiring dialysis and delayed extubation (mechanical ventilation time > 72 hours). Overall incidence of PND and TND was 2.7% and 6.8%, respectively. The incidence of AKI requiring dialysis was 4.1%. The incidence of delayed extubation was 21.9%. No difference of mortality rate or incidence of complications was found between the two groups. The average follow-up was 63.0±33.1 months. The 5-year survival rate was 72.6% in the TAR group and 85.5% in the SAR group. Conclusion Emergent aortic arch replacement using MHCA+UACP can be accomplished with excellent results.