Whole body perfusion strategy for aortic arch repair under moderate hypothermia

Perfusion
Christopher L TarolaMichael W A Chu

Abstract

Aortic arch reconstruction under moderate hypothermia is commonly performed with antegrade cerebral perfusion (ACP) for brain protection; however, hypothermia alone is often solely relied upon for visceral and lower body protection. We investigated whether the addition of simultaneous lower body perfusion to ACP (whole body perfusion - WBP) may ameliorate the metabolic derangements of moderate hypothermic circulatory arrest (MHCA). Between 2008 and 2014, 106 consecutive patients underwent elective or emergent aortic arch surgery with MHCA, with either ACP only (44 patients, 66±12 years, 30% female) or WBP (62 patients, 61±15 years, 31% female). Primary outcomes included 30-day/in-hospital mortality, intensive care unit (ICU) and hospital lengths of stay (LOS) and specific parameters of metabolic recovery. There were no significant differences between the groups in 30-day/in-hospital mortality (ACP: 3 (6.8%), WBP: 2 (3.2%); p=0.65), stroke (ACP: 1 (2.3%), WBP: 1 (1.6%); p=1.0) or renal failure (ACP: 2 (4.5%), WBP: 1 (1.5%); p=0.57). In the WBP group, we identified a significant reduction in lactate level at ICU admission (ACP 5.5 vs. WBP 3.5 mmol/L; p=0.002), time to lactate normalization (p=0.014) and median ICU length-of-stay ...Continue Reading

References

Oct 30, 1999·Journal of Cardiac Surgery·R MatsuwakaN Shinohara
Jun 30, 2004·The Annals of Thoracic Surgery·Justus T StrauchRandall B Griepp
Oct 7, 2006·Journal of Cardiothoracic and Vascular Anesthesia·John G T AugoustidesDavid R Jobes
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Mar 20, 2013·The Journal of Thoracic and Cardiovascular Surgery·Ludhmila A HajjarFilomena R B G Galas
May 1, 2013·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Maximilian LuehrChristian D Etz
Sep 28, 2013·The Annals of Thoracic Surgery·Christian D EtzFriedrich W Mohr
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Aug 4, 2015·The Annals of Thoracic Surgery·Bradley G LeshnowerEdward P Chen
Nov 10, 2015·The Canadian Journal of Cardiology·Michael W A ChuMark D Peterson

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