초록접수 현황
| 16F-149 | 포럼 발표 |
Moderate Hypothermic Circulatory Arrest With or Without Antegrade Cerebral Perfusion Based on the Extent of Aortic Arch Repair
Youjung Ok, Bo Bae Jeon, Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
Background : Recent researches have shown that moderate hypothermic circulatory arrest alone is enough when the duration of arrest for arch repair is less than 30 minutes. Longer circulatory arrest time for more complex arch repair, however, requires additive cerebral perfusion to prevent neurologic damages. This study aims to evaluate an arch repair strategy of moderate hypothermic circulatory arrest with or without cerebral perfusion stratified by the extent of arch repair.
Methods : From January 2012 through July 2016, 105 adult patients (48 female; mean age, 60.2±15.7 years) undergoing arch replacement surgery due to acute aortic syndrome (n=53) or chronic aneurysm (n=45) were enrolled in this study. All patients underwent moderate hypothermic induction (nasopharyngeal temperature=25ºC). Patients undergoing hemiarch repair (n=79) received total circulatory arrest alone while those undergoing total arch repair (n=26) received unilateral antegrade cerebral perfusion during circulatory arrest.
Results : Early mortality occurred in 2 cases (1.9%) who underwent hemiarch repair due to acute type A aortic dissection. There was no permanent neurological injury, but 2 case of temporary neurologic deficit in each of the two groups (1.9%). Other major complications included re-exploration due to bleeding in 11 (10.5%), requirement for ECMO in 5 (4.8%) and new dialysis in 5 (4.8%) without significant differences between hemiarch and total-arch repair groups (P values, 0.11-0.99).
Conclusion : Stratified cerebral perfusion strategy using moderate hypothermia for aortic arch surgery based on the extent of arch repair showed excellent early outcomes with a minimum risk of neurologic injury.
Methods : From January 2012 through July 2016, 105 adult patients (48 female; mean age, 60.2±15.7 years) undergoing arch replacement surgery due to acute aortic syndrome (n=53) or chronic aneurysm (n=45) were enrolled in this study. All patients underwent moderate hypothermic induction (nasopharyngeal temperature=25ºC). Patients undergoing hemiarch repair (n=79) received total circulatory arrest alone while those undergoing total arch repair (n=26) received unilateral antegrade cerebral perfusion during circulatory arrest.
Results : Early mortality occurred in 2 cases (1.9%) who underwent hemiarch repair due to acute type A aortic dissection. There was no permanent neurological injury, but 2 case of temporary neurologic deficit in each of the two groups (1.9%). Other major complications included re-exploration due to bleeding in 11 (10.5%), requirement for ECMO in 5 (4.8%) and new dialysis in 5 (4.8%) without significant differences between hemiarch and total-arch repair groups (P values, 0.11-0.99).
Conclusion : Stratified cerebral perfusion strategy using moderate hypothermia for aortic arch surgery based on the extent of arch repair showed excellent early outcomes with a minimum risk of neurologic injury.
책임저자: Joon Bum Kim
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Korea
발표자: Youjung Ok, E-mail : keinmiel@hanmail.net