scholarly journals Mild Hypothermic Circulatory Arrest with Lower Body Perfusion for Total Arch Replacement Via Upper Hemisternotomy in Acute Type A Dissection

2021 ◽  
Vol 24 (2) ◽  
pp. E345-E350
Author(s):  
Hui Jiang ◽  
Yu Liu ◽  
Zhonglu Yang ◽  
Yuguang Ge ◽  
Yejun Du
Keyword(s):  
Mild Hypothermia ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Lower Body ◽  
Acute Type A Dissection ◽  
Significant Difference ◽  
Type A Dissection

Background: Mild hypothermia circulatory arrest combined with lower body perfusion (LBP) might be beneficial for the recovery of patients with acute type A dissection. However, the safety of mild hypothermic circulatory arrest with LBP used in total arch replacement combined with frozen elephant trunk implantation (FET) via single upper hemisternotomy approach is ambiguous. Methods: We retrospectively analyzed 70 consecutive patients with acute type A dissections who underwent total arch replacement combined with FET between April 2019 to December 2019. These individuals were divided into the moderate (MO) group (N = 39, surgery performed at moderate hypothermic circulatory arrest) and the mild (MI) group (N = 31, surgery conducted at mild hypothermic circulatory arrest with LBP). Perioperative characteristics were recorded. Results: No significant difference in any of the pre- and intraoperative variables was observed between the two groups except for circulatory arrest time, which was significantly shorter in the MI group compared with the MO group [10 (8-11) min vs. 35 (31- 34) min, P = 0.000]. After operation, ventilation times [19 (16 - 24) h vs. 24 (17 - 43) h, P = 0.046] and ICU stay [41 (34 - 58) h vs. 54 (42 - 85) h, P = 0.002] were significantly shorter in the MI group compared with the MO group. Conclusions: Total arch replacement combined with FET at mild hypothermia circulatory arrest with lower body antegrade perfusion via single upper hemisternotomy approach is safe and feasible with significantly shorter time of circulatory arrest compared with no LBP.

scholarly journals Is Total Arch Replacement Associated with an Increased Risk for 30-day Mortality after Surgery for Acute Type A Dissection

2018 ◽  
Vol 66 (S 01) ◽  
pp. S1-S110
Author(s):  
T. Puehler ◽  
M. Salem ◽  
K. Huenges ◽  
B. Panholzer ◽  
C. Friedrich ◽  
...  
Keyword(s):  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Acute Type A Dissection ◽  
Increased Risk ◽  
Type A Dissection

Abstract 751: Retrograde Acute Type A Aortic Dissection: Are Outcomes Worse Than Classic Acute Aortic Dissection?

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Anthony L Estrera ◽  
Charles C Miller ◽  
Ali Azizzadeh ◽  
Taek-Yeon Lee ◽  
Saad Abdullah ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Acute Type A Dissection ◽  
Initial Symptoms ◽  
Type A Dissection ◽  
Poor Outcomes

Introduction: Recent reports of retrograde acute type A aortic dissection (RTAAD) following thoracic aortic endovascular repair have been associated with poor outcomes. This raises concerns about outcomes with RTAAD in general. We report and compare outcomes of retrograde acute Type A aortic dissection repair with classic acute aortic dissection (CAAD). Methods: Between 8/1991 and 5/2008, we repaired 322 patients with acute type A dissection. This cohort was divided into two groups: RTAAD Group (52 cases), and CAAD Group (270 cases). RTAAD was defined as the presence of a dissection tear originating distal to the arch as identified intra-operatively. Tears in the ascending aorta denoted dissection as classic. Repairs using circulatory arrest were similar between groups, p>0.33. Preoperative, operative, and post-operative variables were analyzed retrospectively. Results: Retrograde type A aortic dissection occurred in 16.1% (52/322) of patients. RTAAD differed from CAAD in the median time from initial symptoms to operation (75+−87 hours vs. 47+−61 hours) and specific presenting conditions. (See Table 1 ) Outcomes (stroke: RTAAD, 2.1% vs. CAAD, 3.6%, bleeding: 4% vs. 9%, myocardial infarction: 6% vs. 6%, and mortality: 11% vs. 18%) did not differ significantly between the groups, p>0.05. Conclusions: RTAAD presented later for repair and less frequently with redo-sternotomy and aortic valvular insufficiency. Despite these differences, outcomes from surgical repair did not differ significantly. Acceptable outcomes may be achieved with timely intervention. Table 1: Preoperative Variables

Neurological outcome of hemiarch vs. total arch replacement for acute type A dissection

2005 ◽  
Vol 53 (S 01) ◽  
Author(s):  
R Leyh ◽  
C Hagl ◽  
N Khaladj ◽  
K Kallenbach ◽  
M Karck ◽  
...  
Keyword(s):  
Neurological Outcome ◽  
Type A ◽  
Total Arch Replacement ◽  
Acute Type ◽  
Acute Type A Dissection ◽  
Type A Dissection
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