Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection
| Autor: | Mitsumasa Hata, Tomofumi Umeda, Shinji Wakui, Masashi Tanaka, Kenji Akiyama, Yukihiko Orime |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty 030204 cardiovascular system & hematology Anastomosis Brain Ischemia law.invention Brain ischemia Blood Vessel Prosthesis Implantation 03 medical and health sciences 0302 clinical medicine Hypothermia Induced law medicine.artery medicine Cardiopulmonary bypass Humans Hospital Mortality Cerebral perfusion pressure Aorta Aged Aged 80 and over Aortic dissection Cardiopulmonary Bypass Aortic Aneurysm Thoracic business.industry Anastomosis Surgical General Medicine Middle Aged medicine.disease Surgery Cardiac surgery Perfusion Aortic Dissection Treatment Outcome 030228 respiratory system Cardiothoracic surgery Replantation Anesthesia Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | General Thoracic and Cardiovascular Surgery. 66:33-37 |
| ISSN: | 1863-6713 1863-6705 |
| Popis: | We previously reported a unique technique called “less invasive quick replacement (LIQR)” for treating type A acute aortic dissection with moderate hypothermic arrest (28 °C). This study examines the modified LIQR using mild hypothermic arrest (30 °C) with partial retrograde cerebral perfusion (RCP). 187 patients were divided into 2 groups: group L consisted of 130 patients underwent LIQR without any cerebral perfusion; group M consisted of 57 patients who were treated with modified LIQR. In modified LIQR, circulatory arrest was commenced under the 30 °C for open distal aortic stamp fixation. RCP was used during final half anastomosis of the prosthesis and then rapid re-warming was initiated. The incidence of additional valve or coronary surgeries was significantly higher in group M (28.1%) than in group L (9.2%). The average rectal temperature was significantly higher in group M (29.5 °C) than in group L (27.4 °C). The durations of brain ischemia (M 7.7 min; L 18.6 min), cardiopulmonary bypass (M 82.0 min; L 93.3 min), and overall operation (M 145.2 min; L 154.2 min) were significantly shorter in group M. The incidence of postoperative brain damage was 6 patients (4.6%) in group L, but none in group M. The hospital mortality rate was 3 patients in group L (2.3%). All group M patients were discharged from the hospital without any complications. Modified LIQR is safe and effective. It makes the surgery much quicker and is a less invasive procedure. The surgical outcome was also favorable. |
| Databáze: | OpenAIRE |
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