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Quick Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest

2007; Elsevier BV; Volume: 83; Issue: 3 Linguagem: Inglês

10.1016/j.athoracsur.2006.09.085

1552-6259

Hiroyuki Kamiya, Christian Hagl, Irina Kropivnitskaya, Juergen Weidemann, Klaus Kallenbach, Nawid Khaladj, Axel Haverich, Matthias Karck,

Moyamoya disease diagnosis and treatment

BackgroundThe aim of this study is to evaluate the safety of proximal arch repair using only moderate hypothermic circulatory arrest (HCA) at a temperature of 25°C to 28°C without any adjunctive cerebral protection in comparison with those with moderate HCA and selective cerebral perfusion.MethodsThirty patients who underwent proximal arch repair using moderate HCA without selective cerebral perfusion (SCP) were retrospectively examined and defined as the SCP (−) group. As a control group, 31 patients who underwent moderate HCA and SCP within 10 minutes were included in this study and defined as the SCP (+) group.ResultsMean circulatory arrest time was 9.4 ± 0.8 minutes and 7.5 ± 1.8 minutes (p = 0.0001) and mean nasopharyngeal temperature at the induction of the circulatory arrest was 26.0 ± 1.2°C and 26.8 ± 1.3°C (p = 0.014) in the SCP (+) group and SCP (−) group, respectively. Operative mortality was 3.2% in the SCP (+) group and 3.3% in the SCP (−), and neurologic complications were found in three (9.7%) patients in the SCP (+) group and two (6.7%) patients in the SCP (−) group (p = 0.69).ConclusionsIt was possible to perform proximal arch replacement in selected patients using moderate HCA without any adjunctive cerebral protection with excellent results, and no advantage of the use of SCP was found in patients who required short HCA for proximal arch replacement. The aim of this study is to evaluate the safety of proximal arch repair using only moderate hypothermic circulatory arrest (HCA) at a temperature of 25°C to 28°C without any adjunctive cerebral protection in comparison with those with moderate HCA and selective cerebral perfusion. Thirty patients who underwent proximal arch repair using moderate HCA without selective cerebral perfusion (SCP) were retrospectively examined and defined as the SCP (−) group. As a control group, 31 patients who underwent moderate HCA and SCP within 10 minutes were included in this study and defined as the SCP (+) group. Mean circulatory arrest time was 9.4 ± 0.8 minutes and 7.5 ± 1.8 minutes (p = 0.0001) and mean nasopharyngeal temperature at the induction of the circulatory arrest was 26.0 ± 1.2°C and 26.8 ± 1.3°C (p = 0.014) in the SCP (+) group and SCP (−) group, respectively. Operative mortality was 3.2% in the SCP (+) group and 3.3% in the SCP (−), and neurologic complications were found in three (9.7%) patients in the SCP (+) group and two (6.7%) patients in the SCP (−) group (p = 0.69). It was possible to perform proximal arch replacement in selected patients using moderate HCA without any adjunctive cerebral protection with excellent results, and no advantage of the use of SCP was found in patients who required short HCA for proximal arch replacement.