Different hypothermic and cerebral perfusion strategies in extended arch replacement for acute type a aortic dissection: a retrospective comparative study

• Published in: Journal of cardiothoracic surgery 2020-09, Vol.15 (1), p.236-236, Article 236
• Main Authors: Dong, Song-Bo, Xiong, Jian-Xian, Zhang, Kai, Zheng, Jun, Xu, Shang-Dong, Liu, Yong-Min, Sun, Li-Zhong, Pan, Xu-Dong
• Format: Article
• Language: English
• Subjects: Acute type a aortic dissection; Adult; Analysis; Aneurysm, Dissecting - surgery; Aorta; Aorta, Thoracic - surgery; Aortic dissection; Arterial lines; Bilateral selective antegrade cerebral perfusion; Blood transfusion; Blood Vessel Prosthesis Implantation - adverse effects; Body Temperature; Cardiac function; Carotid arteries; Cerebrovascular Circulation; Coma; Comparative studies; Cooling; Coronary vessels; Dissection; Drainage measurement; Effusion; Elephants; Erythrocytes; Female; Heart Arrest, Induced - adverse effects; Heart Arrest, Induced - methods; Hospital Mortality; Humans; Hypertension; Hypothermia, Induced - adverse effects; Implantation; Intensive Care Units; Length of Stay; Male; Medical imaging; Medical prognosis; Middle Aged; Moderate hypothermic circulatory arrest; Mortality; Nervous System Diseases - etiology; Normal distribution; Paralysis; Paraplegia; Paraplegics; Patients; Perfusion; Perfusion - adverse effects; Perfusion - methods; Renal failure; Respiration, Artificial; Retrospective Studies; Risk Factors; Stents; Surgery; Tamponade; Temperature; Time Factors; Total arch replacement; Transfusion; Veins & arteries; Ventilation
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-020-01284-y

The optimal hypothermic level in total arch replacement with stented elephant trunk implantation for acute type A aortic dissection (aTAAD) has not been established, and the superiority of unilateral or bilateral cerebral perfusion remains a controversial issue. Therefore, we evaluated the application of moderate hypothermic circulatory arrest (MHCA) with a core temperature of 29 °C and bilateral selective antegrade cerebral perfusion in aTAAD treated by total arch replacement with stented elephant trunk implantation. From July 2019 to January 2020, 25 aTAAD patients underwent total arch replacement with stented elephant trunk implantation via MHCA (29 °C) and bilateral selective antegrade cerebral perfusion (modified group). Thirty-six patients treated by the same procedure with MHCA (25 °C) and unilateral selective antegrade cerebral perfusion during this period were selected as controls. There were no differences between the two groups of patients in terms of age, sex, incidence of hypertension, malperfusion, and pericardial effusion, although the incidence of cardiac tamponade was higher in the modified group (control 2.8%, modified 20%; P = 0.038). The lowest mean circulatory arrest temperature was 24.6 ± 0.9 °C in the control group, and 29 ± 0.8 °C in the modified group (P