Abstract
Background: During total aortic arch replacement surgery (TARS) for patients with acute type A aortic dissection, organs in the lower body such as the viscera and spinal cord are at risk of ischemia even when antegrade cerebral perfusion (ACP) is performed. Combining ACP with retrograde inferior vena caval perfusion (RIVP) during TARS may improve outcomes by providing the lower body with oxygenated blood.
Methods: This is a multi-center, randomized, controlled trial of 500 patients scheduled for TARS. Patients were randomly allocated to a moderate hypothermia circulatory arrest (MHCA) group, who received selective ACP with moderate hypothermia during TARS; or to an RIVP group, who received the combination of RIVP and selective ACP under moderate hypothermia during TARS. The primary outcome was a composite of early mortality and major complications, including paraplegia, postoperative renal failure, severe liver dysfunction, postoperative prolonged intubation (>48 h), and gastrointestinal complications.
Discussion: This study aims to assess whether RIVP combined with selective ACP leads to superior outcomes than selective ACP alone for patients undergoing TARS under moderate hypothermia. This study seeks to provide high-quality evidence for RIVP to be used in patients with acute type A aortic dissection undergoing TARS.
Complications of Inferior Vena Caval Filters
