Document Detail

Less invasive quick replacement for octogenarians with type A acute aortic dissection.
MedLine Citation:
PMID:  18692662     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: We assessed the efficacy of our newly modified technique, namely, less invasive quick replacement with rapid rewarming, for octogenarians undergoing emergency surgery for type A acute aortic dissection. METHODS: Forty-two patients with acute aortic dissection, whose average age was 81.7 +/- 2.3 years, were divided into two groups: group I consisted of 25 patients undergoing surgery with deep hypothermic circulatory arrest and selective cerebral perfusion; group II consisted of 17 recent patients who underwent less invasive quick replacement. In the latter technique, during open distal anastomosis with a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40 degrees C accompanied by warming of the patient's body by a heating mat. As soon as the distal anastomosis was completed, rapid rewarming was initiated by 40 degrees C blood perfusion. RESULTS: The durations of cerebral protection (group I, 75.8 minutes, vs group II, 18.8 minutes), cardiopulmonary bypass (I, 201.2, vs II, 84.4 minutes), and overall operation (I, 425.6, vs II, 148.6 minutes) were significantly shorter in group II. In group I, 5 patients had complications of cerebral damage and 5 required re-exploration for bleeding, 7 had pneumonia, 6 required hemodialysis for renal failure, and the hospital mortality rate was 24% (6 patients). On the other hand, no such complications or mortality were observed in group II (P < .0291). Postoperative hospital stay was significantly shorter for the patients in group II than in group I (13.2 days vs 33.7 days; P < .0001). CONCLUSION: Less invasive quick replacement is safe and effective. It should be a standard surgical technique for octogenarians with type A acute aortic dissection.
Mitsumasa Hata; Mitsunori Suzuki; Akira Sezai; Tetsuya Niino; Satoshi Unosawa; Nobuyuki Furukawa; Kazutomo Minami
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-02
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  136     ISSN:  1097-685X     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-08-11     Completed Date:  2008-08-29     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  489-93     Citation Subset:  AIM; IM    
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.
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MeSH Terms
Aneurysm, Dissecting / surgery*
Aorta, Thoracic / surgery
Aortic Aneurysm, Thoracic / surgery*
Blood Vessel Prosthesis Implantation*
Cardiopulmonary Bypass / methods
Heart Arrest, Induced / methods
Hypothermia, Induced / methods

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