The use of profound hypothermia and circulatory arrest in operations on the thoracic aorta1
1997; Oxford University Press; Volume: 11; Issue: 1 Linguagem: Inglês
10.1016/s1010-7940(96)01026-3
ISSN1873-734X
AutoresMarek Ehrlich, Martin Grabenwöger, Doris Luckner, Fabiola Cartes-Zumelzu, Paul Simon, Günther Laufer, Ernst Wolner, Michael Havel,
Tópico(s)Mechanical Circulatory Support Devices
ResumoOBJECTIVE: This retrospective study reviews the contemporary surgicaloutcome of our patients undergoing operations on thoracic aneurysms in deephypothermic circulatory arrest. METHODS: Between January 1989 and February1995, 279 patients were operated on in our institution on various portionsof the aorta. In 143 patients (97 male, 46 female), deep hypothermia andcirculatory arrest were used as the standard operative technique. Patientsage ranged from 16 to 83 years (mean 55). Final indication for operationwas dissection Type A in 80 patients (61 acute, 19 chronic), dissectionType B in 21 patients (17 acute, 4 chronic) and atherosclerotic aneurysmsin 42 patients (11 acute, 31 chronic). 16 patients were operated underpreoperative unstable hemodynamic conditions, 6 patients had beenresuscitated preoperatively. Surgical technique included cardiopulmonarybypass with femoral artery cannulation. For added cerebral protection allpatients received Cortisone and barbiturates right before circulatoryarrest (confirmed by 0-EEG). The segment of the aorta containing the areawith the aneurysm, was resected and replaced with a tubular albumin coatedgraft. RESULTS: The 30-day mortality was 31.15% (19/61) in the acute and23.52% (4/19) in the chronic type A dissection group, 35.29% (6/17) in theacute and 25% (1/4) in the chronic type B group, 36.3% (4/11) in the acuteand 22.58% (7/31) in the chronic atherosclerotic group. Causes ofpostoperative death in order of frequency were: multiorgan failure (n =15), myocardial failure (n = 13), bleeding (n = 4), sepsis (n = 4),myocardial infarction (n = 3) and stroke (n = 2). CONCLUSION: Despiterather high mortality rates in the acute aneurysm groups, the technique ofprofound hypothermic circulatory arrest represents a relatively safe methodfor operations on the thoracic aorta.
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