scholarly journals Severe systemic inflammatory response syndrome in patients following Total aortic arch replacement with deep hypothermic circulatory arrest

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Jun Li ◽  
Lijing Yang ◽  
Guyan Wang ◽  
Yuefu Wang ◽  
Chunrong Wang ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Systemic Inflammatory Response ◽  
Hospital Death ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement

Abstract Background This cohort study aims to retrospectively investigate the incidence of severe systemic inflammatory response syndrome (sSIRS) in patients following total aortic arch replacement (TAR) under deep hypothermic circulatory arrest (DHCA) with selective cerebral perfusion and its effect on clinical outcomes. Methods All patients who underwent TAR with DHCA were consecutively enrolled from January 2013 until December 2015 at our institute. sSIRS was diagnosed between 12 and 48 h postoperatively if patients met all four criteria of the SIRS definition. Results Of the 522 patients undergoing TAR with DHCA, 31.4% developed sSIRS. Patients aged under 60 yr were characterized by a higher prevalence of sSIRS (OR = 2.93; 95% CI 2.01–4.28; P <0.001). Higher baseline serum creatinine (OR = 1.61; 95% CI 1.18–2.20; P = 0.003), concomitant coronary disease (OR = 2.00; 95% CI 1.15–3.48; P = 0.015) and extended cardiopulmonary time (OR = 1.63; 95% CI 1.23–2.18; P = 0.001) independently contributed to a greater likelihood of postoperative sSIRS onset, while the preferred administration of ulinastatin (OR = 0.69; 95% CI 0.51–0.93; P = 0.015) and dexmedetomidine (OR = 0.36; 95% CI 0.23–0.56; P < 0.001) attenuated it. Patients with sSIRS had a greater risk of developing postoperative major adverse complications compared with the no sSIRS group [56.7%(93/164) vs 26.8% (96/358), P < 0.001]. sSIRS was found to be a significant risk factor for major adverse complications (OR, 4.52; 95% CI, 3.40–6.01; P < 0.001). A significant difference was revealed in in-hospital death following TAR between the sSIRS group and the no-sSIRS group [4.88% (8/164) vs 1.12% (4/358), P = 0.019]. The Kaplan-Meier curve indicated that the time to discharge from the intensive care unit was significantly prolonged in the sSIRS group compared with patients without it (log-rank p < 0.001). Conclusions sSIRS occurs commonly in patients following TAR with DHCA. There is an inverse association between age and sSIRS onset, whereby age over 60 yr can lower the risk of it. sSIRS development can increase the likelihood of major postoperative major adverse events.

scholarly journals Moderate and Deep Hypothermic Circulatory Arrest Have Comparable Effects on Severe Systemic Inflammatory Response Syndrome After Total Aortic Arch Replacement in Patients With Type A Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Yinejie Du ◽  
Zhongrong Fang ◽  
Yanhua Sun ◽  
Congya Zhang ◽  
Guiyu Lei ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Type A ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Replacement ◽  
Type A Aortic Dissection ◽  
Total Aortic Arch Replacement ◽  
Before And After

Background: The objective of this study was to compare the incidence of severe systemic inflammatory response syndrome (sSIRS) after total aortic arch replacement between patients who underwent moderate hypothermic circulatory arrest (MHCA) and those who underwent deep hypothermic circulatory arrest (DHCA).Methods: At Fuwai Hospital, 600 patients who underwent total aortic arch replacement with MHCA or DHCA from January 2013 to December 2016 were consecutively enrolled and divided into DHCA (14.1–20.0°C) and MHCA (20.1–28.0°C) groups. Preliminary statistical analysis revealed that some baseline indicators differed between the two groups; therefore, propensity score matching (PSM) was used to balance the covariates. Post-operative sSIRS as the primary outcome was compared between the groups both before and after PSM.Results: A total of 275 (45.8%) patients underwent MHCA, and 325 (54.2%) patients underwent DHCA. After PSM analysis, a total of 191 matched pairs were obtained. The overall incidence of sSIRS was 27.3%. There was no significant difference in post-operative sSIRS between the MHCA group and the DHCA group in either the overall cohort or the PSM cohort (no-PSM: P = 0.188; PSM: P = 0.416); however, post-operative sSIRS was increased by ~4% in the DHCA group compared with the MHCA group in both the no-PSM and PSM cohorts (no-PSM: 29.5 vs. 24.7%; PSM: 29.3 vs. 25.1%). Both before and after PSM, the rates of gastrointestinal hemorrhage and pulmonary infection and post-operative length of stay were significantly increased in the DHCA group compared with the MHCA group (P &lt; 0.05), and the remaining secondary outcomes were not significantly different between the groups.Conclusions: MHCA and DHCA are associated with comparable incidences of sSIRS in patients following total aortic arch replacement for type A aortic dissection. However, the MHCA group had a shorter cardiopulmonary bypass time, a shorter post-operative length of stay and lower pulmonary infection and gastrointestinal hemorrhage rates than the DHCA group. We cautiously recommend the use of MHCA for most total arch replacements in patients with type A aortic dissection.

scholarly journals Aortic Arch Replacement without Deep Hypothermic Circulatory Arrest

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Zviad Bakhutashvili ◽  
Lia Janelidze ◽  
Kakhaber Beria ◽  
Simon Matikashvili ◽  
Eduard Limonjiani
Keyword(s):  
Aortic Valve ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Artery Bypass ◽  
Deep Hypothermic Circulatory Arrest ◽  
Ascending Aorta ◽  
Hypothermic Circulatory Arrest ◽  
Moderate Hypothermia ◽  
Aortic Arch Replacement ◽  
Valve Insufficiency

A 60-year-old man presented with a thoracic aortic aneurysm without rupture accompanied by severe nonrheumatic aortic valve insufficiency and unstable angina. Surgery was performed and included several steps: (1) resection and reconstruction of ascending aorta and aortic arch using a tube graft, (2) replacement of aortic valve using a biological prosthesis, and (3) coronary artery bypass grafting was performed with two distal anastomoses. All of these procedures were performed with total cardiopulmonary bypass without deep hypothermic circulatory arrest under conditions of moderate hypothermia using dual concurrent cannulation of the subclavian and femoral arteries.

A modified procedure in aortic arch replacement with no deep hypothermic circulatory arrest

Perfusion ◽  
2018 ◽  
Vol 33 (8) ◽  
pp. 663-666 ◽  
Author(s):  
Yong Li ◽  
Xiaogang Sun ◽  
Xiuhui Zhang ◽  
Yuchun Zhang ◽  
Guanghui Pang ◽  
...  
Keyword(s):  
Aortic Arch ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Deep Hypothermia ◽  
Morbidity And Mortality ◽  
High Morbidity ◽  
Elephant Trunk ◽  
Aortic Arch Replacement ◽  
Total Aortic Arch Replacement ◽  
Early Results

Deep hypothermia or circulation arrest is widely used during total aortic arch replacement. However, conventional procedures have high morbidity and mortality.1 We use the “branch-first” technique2,3 combined with clamping the distal aorta, incorporating a stented elephant trunk to avoid deep hypothermia and circulation arrest. This technique brings us closer to the goal of arch surgery without cerebral or visceral circulatory arrest and the morbidity of deep hypothermia. Early results are encouraging.

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