ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2020 April;61(2):214-9

DOI: 10.23736/S0021-9509.18.10180-7

Copyright © 2018 EDIZIONI MINERVA MEDICA

lingua: Inglese

An innovative arch-first surgical procedure under moderate hypothermia for acute type A aortic dissection

Kangjun SHEN, Xinmin ZHOU, Ling TAN, Feng LI, Jun XIAO, Hao TANG ✉

Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China

BACKGROUND: We hypothesized that the arch-first procedure without extra devices under moderate-to-mild systemic hypothermia during acute type A aortic dissection is safe and efficient and will improve patient outcome compared with the standard total arch replacement technique.
METHODS: From December 2014 to February 2017, 89 patients were enrolled in this study, 52 of whom underwent conventional deep hypothermic circulatory arrest (DHCA, 24.2±0.71 °C) using the antegrade cerebral perfusion surgical procedure (Group A) and 37 of whom underwent the “arch-first” technique with moderate (27.4±1.1 °C) systemic hypothermia during antegrade cerebral perfusion (Group B). The clinical data, surgical and postoperative data, complications, and mortality of the two groups were analyzed.
RESULTS: The cardiopulmonary bypass (171.3±40.0 min) and awakening time (7.0 hours) was significantly decreased in Group B. Two patients died 30 d after surgery (5.4%, two of 37) in Group B. The incidence of transient neurologic deficit (2.7%) and distal organ complications (5.4%) was lower in Group B.
CONCLUSIONS: In patients with acute type A aortic dissection involving the arch, the innovative arch-first surgical procedure could provide feasible and safe treatment outcomes, which brings us closer to the goal of performing surgery with moderate-to-mild systemic hypothermia with better cerebral, distal organ, and survival outcomes.

KEY WORDS: Dissecting aneurysm; Induced hypothermia; Endovascular procedures