Abstract
We describe a newly modified technique, which we term “less invasive quick replacement” (LIQR) for type A acute aortic dissection (AAD). After cooling to a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed up to 40°C during open distal anastomosis. As soon as the distal anastomosis was completed, rapid rewarming was initiated by perfusing blood at 40°C. The average CPB and total operative times were 71.8 ± 9.6 and 130.6 ± 7.7 min, respectively. The shortest operative time was 101 min from skin incision to skin closure. All patients were weaned off the ventilator within 12 h of surgery. The postoperative hospital stay was 9.3 ± 1.2 days. There was no incidence of cerebral damage or hospital mortality. Our initial results showed LIQR to be safe and effective.
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References
Kawahito K, Adachi H, Yamaguchi A, Ino T. Preoperative risk factors for hospital mortality in acute type A aortic dissection. Ann Thorac Surg 2001;71:1239–1243.
Nakajima T, Kawazoe K, Izumoto H, Kataoka T, Niinuma H, Shirahashi N. Risk factors for hypoxemia after aurgery for acute type A aortic dissection. Surg Today 2006;36:680–685.
Sato Y, Satokawa H, Takase S, Misawa Y, Wakamatsu H, Yokoyama H, et al. Therapeutic strategy for acute type A aortic dissection. Kyobu Geka 2007;60:262–266.
Westaby S, Saito S, Katsumata T. Acute type A dissection: conservative methods provide consistently low mortality. Ann Thorac Surg 2002;73:707–713.
Kamiya H, Hagl C, Kropivnitskaya I, Weidermann J, Haverich A, Karck M, et al. Quick proximal arch replacement with moderate hypothermic circulatory arrest. Ann Thorac Surg 2007;83;1055–1058.
Cook RC, Gao M, Macnab AJ, Fedoruk LM, Day N, Janusz MT. Aortic arch reconstruction: safety of moderate hypothermia and antegrade cerebral perfusion during systemic circulatory arrest. J Cardiovasc Surg 2006;21:158–164.
Greeley WJ, Kern FH, Ungerleider RM, Boyd JL III, Quill T, Smith LR, et al. The effect of hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral metabolism in neonates, infants, and children. J Thorac Cardiovasc Surg 1991;101:783–794.
Rosner MJ, Rosner SD, Johnson AH. Cerebral perfusion pressure: management protocol and clinical results. J Neurosurg 1995;83:949–962.
Croughwell ND, Frasco P, Blumenthal JA, Leone BJ, White WD, Reves JG. Warming during cardiopulmonary bypass is associated with jugular bulb desaturation. Ann Thorac Surg 1992;53:827–832.
Tsui SSL, Schultz JM, Shen I, Ungerleider RM. Postoperative hypoxemia exacerbates potential brain injury after deep hypothermic circulatory arrest. Ann Thorac Surg 2003;78:188–196.
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Hata, M., Suzuki, M., Sezai, A. et al. Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection. Surg Today 39, 353–355 (2009). https://doi.org/10.1007/s00595-008-3864-x
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DOI: https://doi.org/10.1007/s00595-008-3864-x