Objective: We sought to compare the results of ascending aorta-hemiarch replacement by using 2 different methods of cerebral protection in terms of hospital mortality, neurologic outcome, and systemic morbidity and to determine predictive risk factors associated with hospital mortality and neurologic outcome after ascending aorta-hemiarch replacement.

Methods: Between January 1995 and September 2001, 289 patients (mean age, 62.2 +/- 13.2 years; urgent status, 122/289 [42.2%]) underwent ascending aorta-hemiarch replacement with the aid of antegrade selective cerebral perfusion (161 patients) or deep hypothermic circulatory arrest (128 patients).

Results: Overall hospital mortality was 11.4% (deep hypothermic circulatory arrest group, 13.3%; antegrade selective cerebral perfusion group, 9.9%; P =.375). A logistic regression analysis revealed acute type A dissection (P =.001; odds ratio, 4.3) and age of greater than 70 years (P =.019; odds ratio, 2.5) to be independent predictors of hospital mortality. The permanent neurologic dysfunction rate was 9.3% (deep hypothermic circulatory arrest group, 12.5%; antegrade selective cerebral perfusion group, 7.6%; P =.075). Logistic regression analysis revealed acute type A dissection (P =.001; odds ratio, 6.7) and history of cerebral infarction-transient ischemic attack (P =.038; odds ratio, 3.4) to be independent predictors of permanent neurologic dysfunction. The transient neurologic dysfunction rate was 8.0% (deep hypothermic circulatory arrest group, 7.1%; antegrade selective cerebral perfusion group, 8.7%; P =.530). Acute type A dissection (P =.001; odds ratio, 5.1) was indicated as an independent predictor of transient neurologic dysfunction by means of logistic regression. Renal dysfunction (postoperative creatinine level of >250 micromol/L; deep hypothermic circulatory arrest, 10 [7.8%]; antegrade selective cerebral perfusion, 6 [3.7%]; P =.030), as well as prolonged intubation time (deep hypothermic circulatory arrest, 3.8 +/- 6.3 days; antegrade selective cerebral perfusion, 2.2 +/- 2.5 days; P =.005) were more common in the deep hypothermic circulatory arrest group.

Conclusion: The use of antegrade selective cerebral perfusion and deep hypothermic circulatory arrest during ascending aorta-hemiarch replacement resulted in acceptable hospital mortality and neurologic outcome. Reduced postoperative intubation time and better renal function preservation were observed in the antegrade selective cerebral perfusion group.

Download full-text PDF

Source
http://dx.doi.org/10.1067/mtc.2003.8DOI Listing

Publication Analysis

Top Keywords

deep hypothermic
36
hypothermic circulatory
36
circulatory arrest
36
antegrade selective
36
selective cerebral
36
cerebral perfusion
36
ascending aorta-hemiarch
20
hospital mortality
20
odds ratio
20
aorta-hemiarch replacement
16

Similar Publications

Objective: This study aims to investigate the clinical application value of the central venous-arterial carbon dioxide partial pressure difference (Pv-aCO2) in postoperative cognitive dysfunction(POCD) in patients with acute aortic dissection.

Methods: A retrospective analysis was conducted on the general data of 236 patients. Blood gas samples were collected from the arterial and venous lines at various time points during the surgery, including before and after the initiation of cardiopulmonary bypass (CPB), immediately after CPB initiation, before and after deep hypothermic circulatory arrest, 30 min after rewarming, and 5 min before weaning from CPB.

View Article and Find Full Text PDF
Article Synopsis
  • Hibernating animals can significantly lower their body temperature without damaging their organs, potentially due to active hypometabolism.
  • Researchers studied the phosphorylation of Akt to see if metabolism decreases during artificial hypothermia in hamsters.
  • They found that while hypothermia through adenosine A1 receptor activation decreased Akt phosphorylation significantly, anesthesia-induced hypothermia showed only partial reduction without organ damage, indicating both methods allow for regulated metabolic reduction.
View Article and Find Full Text PDF

CHALLENGING PROXIMAL CONTROL FOR OPEN THORACOABDOMINAL REPAIR.

Semin Thorac Cardiovasc Surg

December 2024

Division of Cardiovascular and Thoracic Surgery, UTMB-Galveston, Galveston, TX. Electronic address:

Article Synopsis
  • Proximal control of the thoracic aorta during surgery can be difficult due to the complex nature of thoracoabdominal aortic repairs.
  • Different techniques, including deep hypothermic circulatory arrest and staged methods like the frozen elephant trunk procedure, have been developed to tackle these difficulties.
  • The paper reviews these challenges and explains the reasoning for using various surgical approaches.
View Article and Find Full Text PDF
Article Synopsis
  • Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) are crucial techniques in cardiac surgery that can lead to neuroinflammation through microglia activation in the central nervous system.
  • Research typically focuses on conditions like Alzheimer's and Parkinson's but pays less attention to how these processes occur during cardiac surgery.
  • This review highlights the need to explore microglia’s role in neuroinflammation related to CPB and DHCA, aiming to improve patient outcomes and guide future treatment strategies for cardiac surgery patients.
View Article and Find Full Text PDF

Acute thrombosis of ductus arteriosus aneurysm causing bilateral pulmonary artery occlusion in a neonate.

J Cardiothorac Surg

December 2024

Department of congenital heart surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong Province, China.

A 9-day-old male neonate was found to have a systolic murmur during a routine follow-up for skin jaundice. Imaging revealed a large mass at the bifurcation of the main pulmonary artery, causing significant bilateral stenosis. The patient underwent emergency surgery due to critically compromised pulmonary blood flow.

View Article and Find Full Text PDF

Want AI Summaries of new PubMed Abstracts delivered to your In-box?

Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!