Intermittent upper and lower body perfusion during circulatory arrest is safe for aortic repair

Introduction: We report our initial surgical experience of intermittent upper and lower body retrograde perfusion during aortic repair under circulatory arrest. Methods: Between 2007 and 2015, 148 consecutive patients underwent surgical aortic repair using moderate hypothermic circulatory arrest with intermittent upper and lower body retrograde perfusion. Results: All patients underwent ascending aorta replacement; eight had hemiarch replacement (5.4%) and 92 had aortic root surgery (62.2%). Twenty-nine patients (19.6%) had re-operations and 60 patients (40.5%) had concomitant procedures. The mean duration of circulatory arrest was 23.2 ± 5.4 minutes (range 13-48 minutes). Hospital length of stay was 11.3 ± 16.9 days (median 7.0 days; interquartile range [IQR] 6 days). Complications included death in 0.7%, stroke in 3.4%, respiratory failure in 12.8%, renal replacement therapy in 2.0% and re-exploration for bleeding in 0.7%. Peak renal and hepatic biomarkers were: creatinine 1.2 ± 0.3 mg/dL, aspartate aminotransferase (AST) 291 ± 1112 U/L (IQR 91.8 U/L), alanine aminotransferase (ALT) 212 ± 924 U/L (IQR 43.0 U/L) and total bilirubin 1.2 ± 0.9 mg/dL. Peak lactate was 5.0 ± 3.3 mmol/L (IQR 3.3 mmol/L) and the mean time to normalization (