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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 2018 Mar 12

DOI: 10.23736/S0021-9509.18.10180-7


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, Hunan, PR 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 h) was significantly decreased in Group B. Two patients died 30 d after surgery (5.4%, 2/37) 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: Acute type A aortic dissection - Arch-first - Moderate systemic hypothermia

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Publication History

Article first published online: March 12, 2018
Manuscript accepted: March 12, 2018
Manuscript revised: February 5, 2018
Manuscript received: August 23, 2017

Per citare questo articolo

Shen K, Zhou X, Tan L, Li F, Xiao J, Tang H. An innovative arch-first surgical procedure under moderate hypothermia for acute type A aortic dissection. J Cardiovasc Surg 2018 Mar 12. DOI: 10.23736/S0021-9509.18.10180-7

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