Visceral organ protection in aortic arch surgery: safety of moderate hypothermia

Autor: Davide Pacini, Antonio Pantaleo, Luca Di Marco, Alessandro Leone, Roberto Di Bartolomeo, Giuseppe Barberio, Sebastiano Castrovinci, S. Sottili, Giacomo Murana
Přispěvatelé: Pacini, Davide, Pantaleo, Antonio, di Marco, Luca, Leone, Alessandro, Barberio, Giuseppe, Murana, Giacomo, Castrovinci, Sebastiano, Sottili, Sandra, di Bartolomeo, Roberto
Rok vydání: 2014
Předmět:
Aortic arch
Male
Kidney Disease
Time Factors
medicine.medical_treatment
Aorta
Thoracic
Hypothermia
law.invention
Aortic aneurysm
law
Hypothermia
Induced
Risk Factors
Cardiac Surgical Procedure
Cerebral protection
Cardiopulmonary Bypass
Cardiopulmonary Bypa
Liver Disease
Medicine (all)
Liver Diseases
General Medicine
Middle Aged
Aortic Aneurysm
Anesthesia
Cardiology
Female
Kidney Diseases
Hemodialysis
medicine.symptom
Cardiology and Cardiovascular Medicine
Human
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factor
Visceral protection
Preoperative care
Reperfusion therapy
Internal medicine
medicine.artery
medicine
Cardiopulmonary bypass
Humans
Cardiac Surgical Procedures
Dialysis
Aged
business.industry
Risk Factor
Biomarker
Aortic arch repair
medicine.disease
Surgery
business
Biomarkers
Zdroj: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 46(3)
ISSN: 1873-734X
Popis: Objectives: Although antegrade selective cerebral perfusion (ASCP) provides good brain protection during aortic arch surgery, the issue of distal organ protection during circulatory arrest remains to be clarified. The aim of the study was to retrospectively evaluate the outcome of aortic arch surgery using ASCP at different temperatures, focusing on visceral functions (VFs). Methods: Three hundred and thirty-four patients underwent elective aortic arch surgery using ASCP from November 1996 to March 2011. Those patients without early postoperative low cardiac output syndrome were included. VFs were evaluated by comparing preoperative and postoperative creatinine, aspartate amino transferase, alanine amino transferase and bilirubin. Univariate and multivariate analysis were performed. Results: Three hundred and four patients represent the cohort of the study. Deeper systemic hypothermia (≤25°C) (Group A) was used in 194 patients (63.8%) and moderate hypothermia (>25°C) (Group B) in 110 patients (36.2%). The 30-day mortality rate was 3.6% in Group B and 5.2% in Group A (P = NS). Permanent neurological deficits occurred in 4 (3.6%) and in 14 patients (7.2%) of Group A and Group B, respectively (P = NS). Postoperative renal insufficiency requiring dialysis occurred in 6 patients (5.4%) in Group A and in 15 patients (7.7%) in Group B, the differences were not statistically significant. Biochemical markers of VFs increased in the postoperative period without differences between groups. At the multivariate analysis, cardiopulmonary bypass time >180 min (odds ratio (OR) = 2.16) was the only significant risk factor for renal dysfunction with or without liver dysfunction, while cardiopulmonary bypass time longer than 180min (OR = 2.28) and hypothermia higher than 25°C (OR = 0.54) were found to be independently related to liver dysfunction. Conclusions: Our results confirmed that ASCP with moderate hypothermia at 26°C is a safe method for brain protection. Moreover, during circulatory arrest, moderate hypothermia also offers good protection of visceral organs and it should be preferred for limited periods (
Databáze: OpenAIRE
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