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Title: Safety of Moderate Hypothermia With Antegrade Cerebral Perfusion in Total Aortic Arch Replacement
Austin Authors: Keeling, W Brent;Tian, David H;Leshnower, Brad G;Numata, Satoshi;Hughes, G Chad;Matalanis, George ;Okita, Yutaka;Yan, Tristan D;Kouchoukos, Nicholas;Chen, Edward P
Affiliation: Division of Cardiothoracic Surgery, Emory University Atlanta, GA, USA
The Collaborative Research (CORE) Group International, Macquarie University, Sydney, NSW, Australia
Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
Department of Surgery, Duke University Medical Center, Durham, NC, USA
Department of Cardiac Surgery, Austin Health, Heidelberg, Victoria, Australia
Division of Cardiovascular Surgery, Department of Surgery, Kobe University, Kobe, Japan
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, MI, USA
Issue Date: 19-Nov-2017
Date: 2017-11-19
Publication information: Annals of Thoracic Surgery 2018; 105(1): 54-61
Abstract: BACKGROUND: Total aortic arch replacement (TOTAL) is a complicated operation and has traditionally required deep hypothermic circulatory arrest. In this study, the impact of moderate hypothermic circulatory arrest (MHCA) and antegrade cerebral perfusion (ACP) for TOTAL were examined. METHODS: The ARCH International aortic database was queried and 3,265 patients undergoing TOTAL using ACP were identified. Patients were divided into groups based on lowest cooling temperature: MHCA (20° to 28°C) or deep hypothermia (DHCA) (12° to 20°C). Propensity-matched scoring using 15 variables was used in 669 matched pairs. Multivariable analyses were performed. RESULTS: In the unmatched cohort, more patients underwent MHCA (2,586; 79.2%) who were also younger (p < 0.001) and more frequently underwent emergent operations (p < 0.001) than DHCA patients. For the propensity-matched patients, there were significant differences in cardiopulmonary bypass (CPB) time (MHCA 200 minutes versus DHCA 243 minutes, p < 0.001), aortic crossclamp time (MHCA 120 minutes versus DHCA 142 minutes, p < 0.001), and cerebral perfusion time (MHCA 63 minutes versus DHCA 58 minutes, p < 0.001). Of note, there was no difference in neurologic outcomes nor in-hospital mortality for the two temperature groups. Multivariable analysis of risk factors for mortality included CPB time (odds ratio [OR] 1.006; p < 0.001), concomitant mitral valve surgery (OR 3.070; p = 0.003), emergent operation (OR 2.924; p < 0.001), and poor ejection fraction (OR 3.133; p = 0.011). Independent risk factors for stroke included coronary artery disease (OR 1.856; p < 0.001), cerebral vascular disease (OR 2.172; p < 0.001), emergent operation (OR 2.109; p < 0.001), and CPB time (OR 1.004; p < 0.001). CONCLUSIONS: In this series, TOTAL with MHCA and ACP can be safely performed with acceptable operative risk. MHCA and ACP represent an effective strategy for TOTAL and may obviate the need for DHCA.
DOI: 10.1016/j.athoracsur.2017.06.072
Journal: Annals of Thoracic Surgery
PubMed URL:
Type: Journal Article
Appears in Collections:Journal articles

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