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The Journal of Cardiovascular Surgery 2020 August;61(4):505-11

DOI: 10.23736/S0021-9509.19.10893-2


lingua: Inglese

Evaluation of myocardial injury, the need for vasopressors and inotropic support in beating-heart aortic arch surgery

Tim BERGER 1, 2 , Maximilian KREIBICH 1, 2, Bartosz RYLSKI 1, 2, Julia MORLOCK 1, 2, Stoyan KONDOV 1, 2, Johannes SCHEUMANN 1, 2, Fabian A. KARI 1, 2, 3, Klaus STAIER 3, 4, Sven MAIER 1, 2, Friedhelm BEYERSDORF 1, 2, Martin CZERNY 1, 2, Matthias SIEPE 1, 2

1 Department of Cardiovascular Surgery, University Heart Center, Freiburg University, Freiburg, Germany; 2 Faculty of Medicine, University of Freiburg, Freiburg, Germany; 3 Department of Pediatric Cardiac Surgery, Columbia University Medical Center, New York Presbyterian Morgen Stanley Children’s Hospital, New York, NY, USA; 4 Department of Anesthesiology, University Heart Center, Freiburg University, Bad Krozingen, Germany

BACKGROUND: In contrast to the standard cardioplegic cardiac arrest (CA), some centers prefer the beating-heart technique using selective normothermic myocardial perfusion (SMP) during aortic arch repair. The aim of this study was to evaluate myocardial injury and the need for inotropic and vasopressor support in patients undergoing total aortic arch replacement using SMP or CA during arch repair.
METHODS: Total arch replacement was performed in 127 patients (65 years [IQR: 56-73 years] years) between March 2013 and May 2018 via the frozen elephant trunk technique. Of those, 25 patients were operated on with selective myocardial perfusion. Blood samples and catecholamine doses were evaluated. We compared the SMP group’s and CA group’s outcomes.
RESULTS: The two groups’ risk factors, underlying aortic pathologies, and surgical details were similar. The SMP group’s intraoperative norepinephrine application rates were significantly lower than the CA group’s (P=0.030), as were their postoperative norepinephrine application rates (norepinephrine: P=0.007). Postoperative cardiac enzymes tended to be lower in the SMP group; the difference in creatine-kinase MB reached statistical significance after 14 hours (P=0.024). Intensive care unit stay was significantly shorter in the SMP group (P=0.041), and in-hospital mortality was comparable (4% in the SMP and 11% in the CA group; P=0.46).
CONCLUSIONS: By applying selective normothermic myocardial perfusion, beating-heart aortic arch surgery has the potential to reduce the need for perioperative inotropes, and it might reduce myocardial injury. This approach is a potentially useful adjunct to our armamentarium, particularly in patients with preexisting myocardial damage or in conjunction of arch repair together with other cardiac procedures.

KEY WORDS: Aortic arch syndromes; Myocardial reperfusion injury; Cardiotonic agents

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