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Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection

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Abstract

Objective

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).

Methods

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.

Results

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.

Conclusion

Modified LIQR is safe and effective. It makes the surgery much quicker and is a less invasive procedure. The surgical outcome was also favorable.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi, Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan

    Mitsumasa Hata, Yukihiko Orime, Shinji Wakui, Tomofumi Umeda, Kenji Akiyama & Masashi Tanaka

  2. Department of Cardiovascular Surgery, Nihon University Hospital, 1-6 Kanda Surugadai Chiyoda-ku, Tokyo, 101-8309, Japan

    Mitsumasa Hata

Authors
  1. Mitsumasa Hata
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  2. Yukihiko Orime
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  3. Shinji Wakui
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  4. Tomofumi Umeda
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  5. Kenji Akiyama
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  6. Masashi Tanaka
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Correspondence to Mitsumasa Hata.

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Mitsumasa Hata and other co-authors have no conflicts of interest to declare.

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Hata, M., Orime, Y., Wakui, S. et al. Efficacy of modified less invasive quick replacement using mild hypothermic arrest and partial retrograde cerebral perfusion for type A acute aortic dissection. Gen Thorac Cardiovasc Surg 66, 33–37 (2018). https://doi.org/10.1007/s11748-017-0844-3

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  • DOI: https://doi.org/10.1007/s11748-017-0844-3

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