scholarly journals Moderate hypothermic circulatory arrest in total arch repair for acute type A aortic dissection: clinical safety and efficacy

2016 ◽  
Vol 8 (5) ◽  
pp. 925-933 ◽  
Author(s):  
Ming Gong ◽  
Wei-Guo Ma ◽  
Xin-Liang Guan ◽  
Long-Fei Wang ◽  
Jia-Chen Li ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Clinical Safety ◽  
Type A Aortic Dissection ◽  
Safety And Efficacy

scholarly journals Deep Hypothermic Circulatory Arrest with Lung Perfusion/Ventilation in a Patient with Acute Type A Aortic Dissection

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Yiliam F. Rodriguez-Blanco ◽  
Lester Garcia ◽  
Tania Brice ◽  
Marco Ricci ◽  
Tomas A. Salerno
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Deep Hypothermic Circulatory Arrest ◽  
Lung Perfusion ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Perfusion Technique ◽  
Type A Aortic Dissection ◽  
Potential Benefits

A 50-year-old black male presented with acute type A aortic dissection. Surgical repair was performed under deep hypothermic circulatory arrest (DHCA) with lung perfusion/ventilation throughout the procedure. Details of the lung perfusion technique and its potential benefits and drawbacks are discussed.

scholarly journals A Modified Hypothermic Circulatory Arrest Technique Improves Early and Near-Midterm Results in Patients with Acute Type A Aortic Dissection

2021 ◽  
Vol 24 (4) ◽  
pp. E675-E679
Author(s):  
Huadong Li ◽  
Hong Yu ◽  
Nianguo Dong ◽  
Long Wu
Keyword(s):  
Treatment Group ◽  
Aortic Dissection ◽  
Conventional Treatment ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Midterm Results ◽  
Type A Aortic Dissection ◽  
Conventional Treatment Group

Background: The hypothermic circulatory arrest (HCA) is an indispensable step in the surgical treatment of an acute type A aortic dissection (ATAAD), which could greatly affect the postoperative outcome. We modified the HCA technique and validated the feasibility and superiority of the new approach relative to the conventional method. Methods and results: Eighty-eight patients with ATAAD were enrolled in this study between May 2016 and April 2018. Of those, 36 patients in the Conventional treatment group had circulatory arrest at 25°C for about 16-28 minutes, while 52 patients in the Modification group underwent a circulatory arrest at 28°C for only 1-3 minutes. The preoperative clinical data and postoperative clinical outcomes were compared between the two groups. No intraoperative mortality occurred in any of the cases. No significant differences were observed in the aortic cross-clamp times during the cardiopulmonary bypass (CPB) between the two groups. In the Modification group, several indicators, such as mechanical ventilation time, postoperative 48-h drainage volume, blood transfusion volume, the ICU-stay time and postoperative hospital stay, were reduced significantly as compared with those in the Conventional group. Whereas three postoperative deaths in the hospital occurred in the Conventional treatment group, all the patients in the Modification group were cured. There is no difference in the incidence of postoperative complications between the two groups. The patients had a 100% follow up with a mean of 17 ± 6 months. Conclusions: A moderate hypothermia with a short circulatory arrest is a safe and effective HCA approach that provides satisfactory early and near-midterm results in the patients who received ATAAD treatment.

Colder is better during hypothermic circulatory arrest for acute type a aortic dissection

2012 ◽  
Vol 47 (2) ◽  
pp. 121-128 ◽  
Author(s):  
Antoine Legras ◽  
Matthieu Bruzzi ◽  
Kuniki Nakashima ◽  
Marie-Line Hillion ◽  
Daniel Loisance ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Does Profound Hypothermic Circulatory Arrest Improve Survival in Patients With Acute Type A Aortic Dissection?

Circulation ◽  
2002 ◽  
Vol 106 (12_suppl_1) ◽  
Author(s):  
David T. Lai ◽  
Robert C. Robbins ◽  
R. Scott Mitchell ◽  
Kathleen A. Moore ◽  
Philip E. Oyer ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Cox Regression ◽  
Propensity Score Analysis ◽  
Circulatory Arrest ◽  
Survival Rates ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Reoperation Rates

Objective No evidence exists that profound hypothermic circulatory arrest (PHCA) improves survival or reduces the likelihood of distal aortic reoperation in patients with acute type A aortic dissection. Methods Records of 307 patients with acute type A aortic dissection from 1967 to 1999 were retrospectively reviewed. The influence of repair using PHCA (n=121) versus without PHCA (n=186) on death and freedom from distal aortic reoperation was analyzed using multivariable Cox regression models. Propensity score analysis identified a subset of 152 comparable patients in 3 quintiles (QIII–V) in which the effects of PHCA (n=113) versus no PHCA (n=39) were further compared. Results For all patients, 30-day, 1-year, and 5-year survival estimates were 81±2%, 74±3%, and 63±3% (±1 SE). Survival rates and actual freedom from distal aortic reoperation was not significantly different between treatment methods in the entire patient cohort nor in the matched patients in quintiles III–V. Treatment method was not associated with differences in early major complications, late survival, or distal aortic reoperation rates in the entire patient sample or in quintiles III–V. Conclusions Aortic repair with or without circulatory arrest was associated with comparable early complications, survival, and distal aortic reoperation rates in patients with acute type A aortic dissection. Despite the lack of concrete evidence favoring the use of PHCA, it does no harm, and most of our group uses PHCA regularly because of its practical technical advantages and theoretical potential merit.

Clinical outcomes of a fenestrated frozen elephant trunk technique for acute type A aortic dissection

2020 ◽  
Author(s):  
Homare Okamura ◽  
Yuichiro Kitada ◽  
Atsushi Miyagawa ◽  
Mamoru Arakawa ◽  
Hideo Adachi
Keyword(s):  
Aortic Dissection ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Diameter ◽  
Acute Type ◽  
Frozen Elephant Trunk ◽  
Elephant Trunk ◽  
Type A Aortic Dissection

Abstract OBJECTIVES We investigated the outcomes of a fenestrated frozen elephant trunk (FET) technique performed without reconstruction of one or more supra-aortic vessels for aortic repair in patients with acute type A aortic dissection. METHODS We investigated 22 patients who underwent the fenestrated FET technique for acute type A aortic dissection at our hospital between December 2017 and April 2020. The most common symptom was chest pain and/or back pain. Nine patients presented with malperfusion and 1 with cardiac arrest, preoperatively. A FET was deployed under hypothermic circulatory arrest and manually fenestrated under direct vision. Single fenestration was made in the FET in 15 patients, 2 fenestrations in 5 patients and a total fenestrated technique in 2 patients. Concomitant procedures were performed in 5 patients. RESULTS The cardiopulmonary bypass, aortic cross-clamp and hypothermic circulatory arrest times were 181 ± 49, 106 ± 43 and 37 ± 7 min, respectively. In-hospital mortality, stroke, or recurrent nerve injury did not occur in any patient. One patient developed paraparesis, which completely recovered at discharge. During the follow-up period (mean 18 ± 7 months), 1 patient died of heart failure. Fenestration site occlusion did not occur. Follow-up computed tomography (mean 12 ± 6 months postoperatively) revealed that the maximal aortic diameter remained unchanged at the levels of the distal end of the FET, the 10th thoracic vertebra and the coeliac artery; however, the aortic diameter was significantly reduced at the level of the pulmonary artery bifurcation. CONCLUSIONS The fenestrated FET technique is a simple, safe and effective procedure for selected patients with acute type A aortic dissection.

Is More than One Hour of Selective Antegrade Cerebral Perfusion in Moderate-to-Mild Systemic Hypothermic Circulatory Arrest for Surgery of Acute Type A Aortic Dissection Safe?

2017 ◽  
Vol 66 (03) ◽  
pp. 215-221 ◽  
Author(s):  
Nestoras Papadopoulos ◽  
Petar Risteski ◽  
Theresa Hack ◽  
Mahmut Ay ◽  
Anton Moritz ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Aortic Dissection ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Type A ◽  
Hypothermic Circulatory Arrest ◽  
Acute Type ◽  
Elephant Trunk ◽  
Type A Aortic Dissection ◽  
Antegrade Cerebral Perfusion

Objectives Surgery for acute type A aortic dissection (AAD) remains a surgical challenge with considerable risk of morbidity and mortality. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of brain perfusion during complex aortic arch repair, often necessary in setting of AAD. The safe limits of this approach under moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) are yet to be defined. Thus, the current study investigates our clinical results after surgical treatment for AAD in patients with a selective ACP and systemic circulatory arrest time of ≥ 60 minutes in moderate-to-mild hypothermia (≥ 28°C). Methods Between January 2000 and April 2016, 63 consecutive patients underwent surgical treatment for AAD employing selective ACP during moderate-to-mild systemic hypothermia (≥ 28°C) with prolonged ACP and circulatory arrest times. Patients' mean age was 59 ± 15 years, and 39 patients (62%) were men. Hemiarch replacement and total arch replacement were performed in 13 (21%) and 50 (79%) patients, respectively. Frozen elephant trunk, arch light, and elephant trunk technique were performed in nine (14%), six (10%), and three patients (5%), respectively. Clinical data were prospectively entered into our institutional database. Mean late follow-up was 6 ± 4 years and was 98% complete. Results Cardiopulmonary bypass time accounted for 245 ± 81 minutes and the myocardial ischemic time accounted for 140 ± 43 minutes. Mean duration of ACP was 74 ± 12 minutes. The mean lowest core temperature accounted for 28.9 ± 0.8°C. Unilateral ACP was performed in 44 patients (70%); bilateral ACP was used in the remaining 19 patients (30%). Intensive care unit stay reached 6 ± 5 days. New onset of acute renal failure requiring hemofiltration was observed in 8% of patients (n = 5). New postoperative permanent neurologic deficits were found in five patients (8%) and transient neurologic deficits in six patients (10%). There was one case of paraplegia. Thirty-day mortality and in-hospital mortality were 8 (n = 5) and 11% (n = 7), respectively. Overall survival at 5 years was 76 ± 9%. Conclusion Our preliminary data suggest that selective ACP during moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) can safely be applied for more than 1 hour even in the setting of AAD.

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