Moderate Hypothermia (30 °C) for Surgery of Acute Type A Aortic Dissection

Abstract OBJECTIVE: Antegrade cerebral perfusion has proved to be a reliable method of brain protection during surgery of thoracic aneurysms. In addition, the drawbacks of deep hypothermia may be avoided. This study examines the outcome after surgery for acute type A aortic dissections (AAD) using m...

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Veröffentlicht in:The Thoracic and cardiovascular surgeon 2005-04, Vol.53 (2), p.74-79
Hauptverfasser: Zierer, A., Aybek, T., Risteski, P., Dogan, S., Wimmer-Greinecker, G., Moritz, A.
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container_end_page 79
container_issue 2
container_start_page 74
container_title The Thoracic and cardiovascular surgeon
container_volume 53
creator Zierer, A.
Aybek, T.
Risteski, P.
Dogan, S.
Wimmer-Greinecker, G.
Moritz, A.
description Abstract OBJECTIVE: Antegrade cerebral perfusion has proved to be a reliable method of brain protection during surgery of thoracic aneurysms. In addition, the drawbacks of deep hypothermia may be avoided. This study examines the outcome after surgery for acute type A aortic dissections (AAD) using moderate (30 °C) systemic hypothermia compared with conventional techniques of cerebral protection. METHODS: Between January 1999 and August 2003, 74 patients underwent repair of acute type A aortic dissection. Moderate systemic hypothermia (30 °C) with selective antegrade cerebral perfusion through subclavian artery (group A) was used in 18 patients. Deep hypothermia (20 - 24 °C) was employed using either retrograde (18 patients, group B) or antegrade (38 patients, group C) cerebral perfusion. Tube graft replacement was performed in 55, valve-sparing procedure in 8, and composite graft replacement in 11 patients. RESULTS: The 30-day mortality was 5.5 % in group A, 5.5 % in group B, and 15.8 % in group C (A vs. C and B vs. C; P < 0.01). New postoperative permanent neurologic deficit occurred in 5.5 % of patients in group A, 16.7 % in group B, and 13.2 % in group C. Mean chest tube drainage within the first 24 h in groups A, B and C was 703 ± 338, 1178 ± 820, and 1447 ± 802 ml, respectively (A vs. B and A vs. C; P < 0.01). Cardiopulmonary bypass, ICU, and hospital times were significantly shorter in group A. CONCLUSIONS: Selective antegrade cerebral perfusion with moderate systemic hypothermia appears to be a safe and sufficient tool for brain protection during AAD repair. In avoiding deep hypothermia, this technique may help to reduce cardiopulmonary bypass time and hypothermia-related side effects.
doi_str_mv 10.1055/s-2004-830458
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In addition, the drawbacks of deep hypothermia may be avoided. This study examines the outcome after surgery for acute type A aortic dissections (AAD) using moderate (30 °C) systemic hypothermia compared with conventional techniques of cerebral protection. METHODS: Between January 1999 and August 2003, 74 patients underwent repair of acute type A aortic dissection. Moderate systemic hypothermia (30 °C) with selective antegrade cerebral perfusion through subclavian artery (group A) was used in 18 patients. Deep hypothermia (20 - 24 °C) was employed using either retrograde (18 patients, group B) or antegrade (38 patients, group C) cerebral perfusion. Tube graft replacement was performed in 55, valve-sparing procedure in 8, and composite graft replacement in 11 patients. RESULTS: The 30-day mortality was 5.5 % in group A, 5.5 % in group B, and 15.8 % in group C (A vs. C and B vs. C; P &lt; 0.01). New postoperative permanent neurologic deficit occurred in 5.5 % of patients in group A, 16.7 % in group B, and 13.2 % in group C. Mean chest tube drainage within the first 24 h in groups A, B and C was 703 ± 338, 1178 ± 820, and 1447 ± 802 ml, respectively (A vs. B and A vs. C; P &lt; 0.01). Cardiopulmonary bypass, ICU, and hospital times were significantly shorter in group A. CONCLUSIONS: Selective antegrade cerebral perfusion with moderate systemic hypothermia appears to be a safe and sufficient tool for brain protection during AAD repair. 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In addition, the drawbacks of deep hypothermia may be avoided. This study examines the outcome after surgery for acute type A aortic dissections (AAD) using moderate (30 °C) systemic hypothermia compared with conventional techniques of cerebral protection. METHODS: Between January 1999 and August 2003, 74 patients underwent repair of acute type A aortic dissection. Moderate systemic hypothermia (30 °C) with selective antegrade cerebral perfusion through subclavian artery (group A) was used in 18 patients. Deep hypothermia (20 - 24 °C) was employed using either retrograde (18 patients, group B) or antegrade (38 patients, group C) cerebral perfusion. Tube graft replacement was performed in 55, valve-sparing procedure in 8, and composite graft replacement in 11 patients. RESULTS: The 30-day mortality was 5.5 % in group A, 5.5 % in group B, and 15.8 % in group C (A vs. C and B vs. C; P &lt; 0.01). New postoperative permanent neurologic deficit occurred in 5.5 % of patients in group A, 16.7 % in group B, and 13.2 % in group C. Mean chest tube drainage within the first 24 h in groups A, B and C was 703 ± 338, 1178 ± 820, and 1447 ± 802 ml, respectively (A vs. B and A vs. C; P &lt; 0.01). Cardiopulmonary bypass, ICU, and hospital times were significantly shorter in group A. CONCLUSIONS: Selective antegrade cerebral perfusion with moderate systemic hypothermia appears to be a safe and sufficient tool for brain protection during AAD repair. 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In addition, the drawbacks of deep hypothermia may be avoided. This study examines the outcome after surgery for acute type A aortic dissections (AAD) using moderate (30 °C) systemic hypothermia compared with conventional techniques of cerebral protection. METHODS: Between January 1999 and August 2003, 74 patients underwent repair of acute type A aortic dissection. Moderate systemic hypothermia (30 °C) with selective antegrade cerebral perfusion through subclavian artery (group A) was used in 18 patients. Deep hypothermia (20 - 24 °C) was employed using either retrograde (18 patients, group B) or antegrade (38 patients, group C) cerebral perfusion. Tube graft replacement was performed in 55, valve-sparing procedure in 8, and composite graft replacement in 11 patients. RESULTS: The 30-day mortality was 5.5 % in group A, 5.5 % in group B, and 15.8 % in group C (A vs. C and B vs. C; P &lt; 0.01). New postoperative permanent neurologic deficit occurred in 5.5 % of patients in group A, 16.7 % in group B, and 13.2 % in group C. Mean chest tube drainage within the first 24 h in groups A, B and C was 703 ± 338, 1178 ± 820, and 1447 ± 802 ml, respectively (A vs. B and A vs. C; P &lt; 0.01). Cardiopulmonary bypass, ICU, and hospital times were significantly shorter in group A. CONCLUSIONS: Selective antegrade cerebral perfusion with moderate systemic hypothermia appears to be a safe and sufficient tool for brain protection during AAD repair. In avoiding deep hypothermia, this technique may help to reduce cardiopulmonary bypass time and hypothermia-related side effects.</abstract><cop>Germany</cop><pmid>15786004</pmid><doi>10.1055/s-2004-830458</doi><tpages>6</tpages></addata></record>
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subjects Aneurysm, Dissecting - surgery
Aortic Aneurysm - surgery
Brain - metabolism
Brain Ischemia - prevention & control
Cardiopulmonary Bypass
Case-Control Studies
Cerebrovascular Circulation
Female
Humans
Hypothermia, Induced
Intraoperative Complications - prevention & control
Male
Middle Aged
Original Cardiovascular
Perfusion - methods
Subclavian Artery
Vena Cava, Superior
title Moderate Hypothermia (30 °C) for Surgery of Acute Type A Aortic Dissection
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