Aortic arch surgery using selective antegrade cerebral perfusion and mild hypothermia

Abstract

BackgroundMany studies have shown the benefits of deep hypothermia on cerebral protection during arch surgery; however this has a deleterious effect on endothelial function, coagulation & renal functions. Our aim from this study was to show that we could achieve cerebral protection by using selective antegrade cerebral perfusion (SACP) and mild hypothermia, hence avoiding the side effects of deep hypothermia. MethodsIn this retrospective analytical study, the computerised database was interrogated retrospectively to identify all patients who underwent full arch or hemi-arch replacement with the utilisation of open distal anastomosis technique. The cases retrieved were operated on between August 2003 and September 2013, in the Lancashire cardiac center, Blackpool Victoria Hospital. The main indication of surgery was based on size criteria. A total of 73 patients were identified for inclusion in the study. All patients had SACP along with a period of lower body circulatory arrest at mild systemic hypothermia. 22 patients including 9 (40.9%) men underwent full arch replacement (Group A) and 51 had hemi-arch replacement which included 43 (66.7%) men (Group B). ResultsThe arch group (Group A) had no neurological complications. In the hemi-arch group (Group B), 2 patients (3.9%) had cerebrovascular events but there were no cases of paraplegia. Temporary hemofiltration was required in 1 patient (4.5%) in Group I and 2 patients (3.9%) in Group II. Further, 2 patients (9.1%) in the arch group and 3(6%) in the hemi-arch group had renal dysfunction not needing dialysis. Mean ICU stay was 2 days (±6.5 days) in the arch group and 1 day (±13.9 days) in the hemi-arch group. Overall there were 4 in-hospital deaths including 2 (9.1%) in the arch group and 2 (3.9%) in the hemi-arch group. There was no significant statistical difference between the two groups. ConclusionThe study showed outcomes comparable to other previous larger studies and adds to the available evidence in favour of this approach.