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Title: Branch-first aortic arch replacement with no circulatory arrest or deep hypothermia.
Austin Authors: Matalanis, George ;Koirala, Rhiannon S;Shi, William Y;Hayward, Philip A R;McCall, Peter R 
Affiliation: Department of Cardiac Surgery, Austin Hospital, University of Melbourne, Melbourne, Australia
Issue Date: 16-Feb-2011
Publication information: The Journal of Thoracic and Cardiovascular Surgery 2011; 142(4): 809-15
Abstract: For aortic arch surgery, the potential risks of deep hypothermic circulatory arrest with or without antegrade cerebral perfusion have been widely documented. We hereby describe our early experience with a "branch-first continuous perfusion" technique that, by avoiding deep hypothermia and circulatory arrest, has the potential to reduce morbidity and mortality.Arterial perfusion is peripheral using femoral and axillary inflows. Disconnection of each arch branch, and anastomosis to the trifurcation graft, proceeds sequentially from the innominate to the left subclavian artery, with continuous perfusion of the heart and viscera by lower body and brain by upper body arterial return. After the descending aorta is clamped, the debranched arch may then be replaced and connected to the ascending aorta before the common stem of the trifurcation graft is joined to the arch graft. Thirty patients underwent this technique. Twelve patients were operated on for aortic dissection and the remainder for aneurysms.With experience, minimum pump temperature rose from 16°C to 34°C. There was 1 (3.3%) death, and 2 (6.7%) patients had neurological dysfunction. Extubation was achieved within 24 hours in 12 (40%) patients, whereas 14 (47%) left the intensive care unit within 2 days. Ten (33%) patients were discharged from the hospital within 7 days. Eight (27%) patients required no transfusion of blood or blood products.This technique brings us closer to the goal of arch surgery without cerebral or visceral circulatory arrest and the morbidity of deep hypothermia. Early results are encouraging.
Gov't Doc #: 21329948
DOI: 10.1016/j.jtcvs.2011.01.020
Journal: The Journal of thoracic and cardiovascular surgery
Type: Journal Article
Subjects: Aged
Blood Vessel Prosthesis Implantation.adverse effects.methods.mortality
Cardiopulmonary Bypass
Cerebrovascular Circulation
Circulatory Arrest, Deep Hypothermia Induced
Middle Aged
Perfusion.adverse effects.methods
Regional Blood Flow
Time Factors
Treatment Outcome
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