Effects of deep hypothermic circulatory arrest on outcome after resection of ascending aortic aneurysm

2002 ◽  
Vol 74 (2) ◽  
pp. 422-425 ◽  
Author(s):  
Franz F Immer ◽  
Hanna Barmettler ◽  
Pascal A Berdat ◽  
Alexsandra S Immer-Bansi ◽  
Lars Englberger ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Ascending Aortic Aneurysm

Open Distal Anastomosis Technique for Ascending Aortic Aneurysm Repair without Cerebral Perfusion

2015 ◽  
Vol 18 (4) ◽  
pp. 124
Author(s):  
Mehmet Kaplan ◽  
Bahar Temur ◽  
Tolga Can ◽  
Gunseli Abay ◽  
Adlan Olsun ◽  
...  
Keyword(s):  
Aortic Aneurysm ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Distal Anastomosis ◽  
Ascending Aortic Aneurysm ◽  
Aortic Aneurysm Surgery ◽  
Aneurysm Repair ◽  
Aortic Aneurysm Repair

<p><strong>Background</strong><strong>: </strong>This study aimed to report the outcomes of patients who underwent proximal thoracic aortic aneurysm surgery with open distal anastomosis technique but without cerebral perfusion, instead under deep hypothermic circulatory arrest.</p><p><strong>Methods: </strong>Thirty patients (21 male, 9 female) who underwent ascending aortic aneurysm repair with open distal anastomosis technique were included. The average age was 60.2±11.7 years. Operations were performed under deep hypothermic circulatory arrest and the cannulation for cardiopulmonary bypass was first done over the aneurysmatic segment and then moved over the graft. Intraoperative and early postoperative mortality and morbidity outcomes were reported.</p><p><strong>Results</strong><strong>: </strong>Average duration of cardiopulmonary bypass and cross-clamps were 210.8±43 and 154.9±35.4 minutes, respectively. Average duration of total circulatory arrest was 25.2±2.4 minutes. There was one hospital death (3.3%) due to chronic obstructive pulmonary disease at postoperative day 22. No neurological dysfunction was observed during the postoperative period.<strong></strong></p><p><strong>Conclusion: </strong>These results demonstrate that open distal anastomosis under less than 30 minutes of deep hypothermic circulatory arrest without antegrade or retrograde cerebral perfusion and cannulation of the aneurysmatic segment is a safe and reliable procedure in patients undergoing proximal thoracic aortic aneurysm surgery.</p><p> </p>

scholarly journals Early postoperative effects of the hypothermia level during hypothermic circulatory arrest in patients with ascending aortic aneurysm

2020 ◽  
Vol 25 (8) ◽  
pp. 3419
Author(s):  
B. N. Kozlov ◽  
D. S. Panfilov ◽  
E. L. Sonduev ◽  
I. V. Ponomarenko
Keyword(s):  
Aortic Aneurysm ◽  
Mild Hypothermia ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Ascending Aortic Aneurysm ◽  
Significant Difference ◽  
Temperature Regimen ◽  
Hypothermia Group ◽  
Hemiarch Replacement

Aim. To compare the effectiveness and safety of ascending aortic hemiarch replacement performed during hypothermic circulatory arrest with different temperature regimens.Material and methods. The study included 104 patients with ascending aortic aneurysm, who underwent ascending aortic hemiarch replacement under hypothermic circulatory arrest and antegrade cerebral perfusion. Depending on the temperature regimen, all patients were divided into two comparable groups: group 1 (n=28) — patients operated on under mild hypothermia (29-31oС), group 2 (n=76) — patients operated on under moderate hypothermia (25-28oC).Results. Comparative analysis of intraoperative data between groups of patients with mild and moderate hypothermia revealed a significant difference in the duration of cardiopulmonary bypass (111 [97; 135] min vs 125 [108.5; 170] min, p=0,031) and surgery (240 [210; 270 ] min vs 275 [240; 330] min, p=0,003). In the early postoperative period, the best results were also obtained in patients of mild hypothermia group. In these patients, compared with moderate hypothermia group, there was a lower frequency of reoperation due to bleeding (3,5% vs 5,2%, p=0,572), a decrease in transfused fresh frozen plasma volume (2 [2; 4] vs 4 [2; 4], p=0,03), a decrease in the ventilatory support duration (10 [7; 16] hours vs 18 [10; 24] hours, p=0,002), as well as a bed-day decrease in intensive care unit (2 [2; 3] and 3 [2; 4] days, p=0,005). No neurologic deficit was found in any of the patients. In-hospital mortality had no significant intergroup differences (p=0,541).Conclusion. An increase in the temperature regimen during the ascending aortic hemiarch replacement performed under hypothermic circulatory arrest is relatively safe in relation to early postoperative complications. Mild hypothermia does not increase early postoperative surgical risks compared to moderate hypothermia.

Repair of Thoracic Aortic Aneurysm and Dissection Using Deep-Hypothermic Circulatory Arrest

1998 ◽  
Vol 6 (2) ◽  
pp. 95-100 ◽  
Author(s):  
Adrian E Manapat ◽  
Jorge M Garcia ◽  
Joseph B Barril ◽  
Gary A Lopez ◽  
Diomedes A Talavera
Keyword(s):  
Aortic Aneurysm ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Aneurysms ◽  
Right Atrial ◽  
Retrograde Cerebral Perfusion ◽  
Aortic Aneurysm And Dissection

From October 1989 to September 1997, 14 patients underwent repair of a thoracic aortic aneurysm or dissection using deep-hypothermic circulatory arrest. There were 10 males and 4 females with a mean age of 58 years (range, 43 to 82 years). The diagnoses included one ascending aortic aneurysm, one ascending aortic and arch aneurysm, 2 aortic arch and descending aortic aneurysms, 4 descending aortic aneurysms, 2 chronic aortic dissections of type A and 4 of type B. The involved aortic segment was replaced with a woven Dacron tube graft in 11 patients and repaired with a patch of woven Dacron in the other 3. Concomitant procedures were coronary artery bypass grafting in 2 cases; one aortic valve replacement, and one wedge resection of the left-upper lobe of the lung. A median sternotomy approach was used in 6 patients of whom 5 had right atrial-femoral artery bypass and 1 had right atrial-ascending aortic bypass. In addition to sternotomy, one patient had a left anterolateral thoracotomy. Seven patients had a left posterolateral thoracotomy with femorofemoral bypass. The mean circulatory arrest time was 35 minutes (range, 13 to 59 minutes). The lowest perfusion temperature ranged from 7°C to 16°C. Retrograde cerebral perfusion was used in 5 patients. There was one operative death from massive bleeding. Early complications included stroke in 2 patients, vocal cord paralysis in one, prolonged ventilatory support in one, reoperation for bleeding in one, and pleural effusion in 3 patients. There were 2 late deaths and the 11 surviving patients (78%) have been followed up for a mean period of 18 months. Deep-hypothermic circulatory arrest was found to be a useful technique in the repair of aortic aneurysm and dissection. We consider retrograde cerebral perfusion to be safe and easily performed. It probably decreased the incidence of stroke in patients with involvement of the aortic arch.

scholarly journals Varying Evidence on Deep Hypothermic Circulatory Arrest in Thoracic Aortic Aneurysm Surgery

2018 ◽  
Vol 45 (2) ◽  
pp. 70-75 ◽  
Author(s):  
Prity Gupta ◽  
Amer Harky ◽  
Saleem Jahangeer ◽  
Benjamin Adams ◽  
Mohamad Bashir
Keyword(s):  
Aortic Aneurysm ◽  
Literature Review ◽  
Cerebral Perfusion ◽  
Thoracic Aortic Aneurysm ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aneurysm Surgery ◽  
Aortic Repair ◽  
Aortic Aneurysm Surgery

Cardiovascular surgeons have long debated the safe duration of deep hypothermic circulatory arrest during thoracic aortic aneurysm surgery. The rationale for using adjunctive cerebral perfusion (or not) is to achieve the best technical aortic repair with the lowest risk of morbidity and death. In this literature review, we highlight the debates surrounding these issues, evaluate the disparate findings on deep hypothermic circulatory arrest durations and temperatures, and consider the usefulness of adjunctive perfusion.

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