Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience

Abstract Background The aim of the study was to assess the indications, surgical strategies, and outcomes after reoperative aortic arch surgery performed generally under mild hypothermia. Methods Ninety consecutive patients (60 males, mean age, 55 ± 16 years) underwent open reoperative aortic arch surgery after previous cardiac aortic surgery. The indications included chronic-progressive arch aneurysm (55.5%), chronic aortic dissection (17.8%), contained arch rupture (16.7%), and graft infection (10%). The reoperation was performed through a repeat sternotomy (96%) or clamshell thoracotomy (4%) using antegrade cerebral perfusion under mild systemic hypothermia (28.9 ± 2.5°C) in all except three patients. Results The surgery comprised hemiarch or total arch replacement in 41 (46%) and 49 (54%) patients, respectively. The distal extension included classic or frozen elephant trunk technique, each in 12 patients, and total descending aorta replacement in 4 patients. Operative mortality was 6 (6.7%) among all patients, with age identified as the only independent predictor of operative mortality (p = 0.05). Permanent and transient neurologic deficits occurred in 1% and 9% of the patients, respectively. Estimated survival at 8 years was 59 ± 8% with advanced heart failure predictive for late mortality (p = 0.014). Freedom from second reoperation or intervention on the aorta was 78 ± 6% at 8 years, with most of these events occurring downstream in patients with chronic degenerative aneurysms. Conclusion Aortic arch reoperations performed using antegrade cerebral perfusion under mild systemic hypothermia offer favorable operative outcomes with an exceptionally low rate of neurologic morbidity without any difference between hemiarch and complex arch procedures.

Download Full-text

Aortic Arch Surgery using Moderate Systemic Hypothermia and Antegrade Cerebral Perfusion via the Right Subclavian Artery*

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2001-17806 ◽

2001 ◽

Vol 49 (5) ◽

pp. 283-286 ◽

Cited By ~ 11

Author(s):

H. Aebert ◽

D. Reber ◽

R. Kobuch ◽

A. Philipp ◽

D. E. Birnbaum

Keyword(s):

Aortic Arch ◽

Subclavian Artery ◽

Cerebral Perfusion ◽

Aortic Arch Surgery ◽

Systemic Hypothermia ◽

The Right ◽

Antegrade Cerebral Perfusion

Download Full-text

Selective Antegrade Cerebral Perfusion during Mild to Moderate (≥ 28°C) Systemic Hypothermia can Safely and Reproducibly Be Apllied to All Aspects of Aortic Arch Surgery: Single Center Experience in 587 Consecutive Patients over a 15 Year Period

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0036-1571652 ◽

2016 ◽

Vol 64 (S 01) ◽

Author(s):

A. El-Sayed Ahmad ◽

P. Risteski ◽

N. Papadopoulos ◽

M. Radwan ◽

A. Moritz ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Single Center ◽

Aortic Arch Surgery ◽

Single Center Experience ◽

Systemic Hypothermia ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Download Full-text

The Standardized Concept of Moderate-to-Mild (≥28°C) Systemic Hypothermia During Selective Antegrade Cerebral Perfusion for All-Comers in Aortic Arch Surgery: Single-Center Experience in 587 Consecutive Patients Over a 15-Year Period

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2016.10.024 ◽

2017 ◽

Vol 104 (1) ◽

pp. 49-55 ◽

Cited By ~ 15

Author(s):

Ali El-Sayed Ahmad ◽

Nestoras Papadopoulos ◽

Petar Risteski ◽

Anton Moritz ◽

Andreas Zierer

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Single Center ◽

Aortic Arch Surgery ◽

Single Center Experience ◽

Systemic Hypothermia ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Download Full-text

Aortic arch surgery using selective antegrade cerebral perfusion and mild hypothermia

Journal of the Egyptian Society of Cardio-Thoracic Surgery ◽

10.1016/j.jescts.2016.04.006 ◽

2016 ◽

Vol 24 (2) ◽

pp. 116-122 ◽

Cited By ~ 1

Author(s):

Faisal Mourad ◽

Vivek Srivastava ◽

Andrew Duncan

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Mild Hypothermia ◽

Aortic Arch Surgery ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

Download Full-text

Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single centre experience in 245 consecutive patients

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1246767 ◽

2010 ◽

Vol 58 (S 01) ◽

Author(s):

A Zierer ◽

F Detho ◽

S Koenig ◽

O Dzemali ◽

A Rouhollahpour ◽

...

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Mild Hypothermia ◽

Single Centre ◽

Aortic Arch Replacement ◽

Single Centre Experience ◽

Antegrade Cerebral Perfusion

Download Full-text

Antegrade cerebral perfusion with mild hypothermia (28-30°C) provides save visceral organ protection during aortic arch replacement

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269132 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

A Zierer ◽

F Detho ◽

M Doss ◽

S Martens ◽

A Moritz

Keyword(s):

Aortic Arch ◽

Cerebral Perfusion ◽

Mild Hypothermia ◽

Visceral Organ ◽

Organ Protection ◽

Aortic Arch Replacement ◽

Antegrade Cerebral Perfusion

Download Full-text

Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i3.65 ◽

2019 ◽

Vol 1 (3) ◽

pp. 99-104

Author(s):

Mohamed Abdel Fouly

Keyword(s):

Cerebral Infarction ◽

Aortic Arch ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Aortic Arch Surgery ◽

Significant Difference ◽

Arch Reconstruction ◽

Antegrade Cerebral Perfusion

Background: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

Download Full-text

Minimally Invasive Aortic Arch Repair: Technical Considerations and Mid-Term Outcomes

The Heart Surgery Forum ◽

10.1532/hsf.3235 ◽

2020 ◽

Vol 23 (6) ◽

pp. E803-E808

Author(s):

Petar Risteski ◽

Medhat Radwan ◽

Gjoko Boshkoski ◽

Razan Salem ◽

Annarita Iavazzo ◽

...

Keyword(s):

Aortic Arch ◽

Median Sternotomy ◽

Minimal Invasive ◽

Minimal Access ◽

Organ Protection ◽

Elephant Trunk ◽

Aortic Arch Surgery ◽

Cord Injury ◽

Systemic Hypothermia ◽

Aortic Arch Repair

Background: Reports of minimal invasive aortic arch surgery are scarce. We reviewed our experience with minimal access aortic arch surgery performed through an upper mini-sternotomy, with emphasis on details of operative technique and early and mid-term outcomes. Methods: The medical records of 123 adult patients (mean age 66 ± 12 years), who underwent primary elective minimal access aortic arch surgery in two aortic referral centers, were reviewed. The most common indication was degenerative aortic arch aneurysm in 92 (75%) patients. Standard operative and organ protection techniques used in all patients were upper mini-sternotomy, uninterrupted antegrade cerebral perfusion, and moderate systemic hypothermia (27.4 ± 1°C). Results: Sixty-eight (55%) patients received partial aortic arch replacement; the remaining 55 (45%) patients received total arch replacement, further extended with either a frozen elephant trunk in 43 (35%) patients or a conventional elephant trunk procedure in nine (7%) patients. No conversion to full sternotomy was required. New permanent renal failure occurred in one (0.8%) patient, stroke in two (1.6%), and spinal cord injury in four (3.3%) patients. Early mortality was observed in four (3.3%) patients. At five years, survival was 80 ± 6% and freedom from reoperation was 96 ± 3%. Conclusion: Minimal invasive aortic arch repair through an upper mini-sternotomy can be safely performed, with early and mid-term outcomes well comparable to series performed through a standard median sternotomy.

Download Full-text