Document Detail


Results of proximal arch replacement using deep hypothermia for circulatory arrest: is moderate hypothermia really justifiable?
MedLine Citation:
PMID:  22196653     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The use of selective cerebral perfusion with warmer temperatures during circulatory arrest has been increasingly used for arch replacement over concerns regarding the safety of deep hypothermic circulatory arrest (DHCA). However, little data actually exist on outcomes after arch replacement and DHCA. This study examines modern results with DHCA for proximal arch replacement to provide a benchmark for comparison against outcomes with lesser degrees of hypothermia. Between July 2005 and June 2010, 245 proximal arch replacements ("hemiarch") were performed using deep hypothermia; mean minimum core and nasopharyngeal temperatures were 18.0 ± 2.1°C and 14.1 ± 1.6°C, respectively. Adjunctive cerebral perfusion was used in all cases. Concomitant ascending aortic replacement was performed in 41 per cent, ascending plus aortic valve replacement in 23 per cent, and aortic root replacement in 32 per cent. Mean age was 58 ± 14 years; 36 per cent procedures were urgent/emergent. Mean duration of DHCA was 20.4 ± 6.2 minutes. Thirty-day/in-hospital mortality was 2.9 per cent. Rates of stroke, renal failure, and respiratory failure were 4.1 per cent (0.8% for elective cases), 1.2 per cent, and 0.4 per cent, respectively. Deep hypothermia with adjunctive cerebral perfusion for circulatory arrest during proximal arch replacement affords excellent neurologic as well as nonneurologic outcomes. Centers using lesser degrees of hypothermia for arch surgery, the safety of which remains unproven, should ensure comparable results.
Authors:
Brian Lima; Judson B Williams; S Dave Bhattacharya; Asad A Shah; Nicholas Andersen; Jeffrey G Gaca; G Chad Hughes
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  The American surgeon     Volume:  77     ISSN:  1555-9823     ISO Abbreviation:  Am Surg     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-12-26     Completed Date:  2012-02-21     Revised Date:  2013-08-15    
Medline Journal Info:
Nlm Unique ID:  0370522     Medline TA:  Am Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1438-44     Citation Subset:  IM    
Affiliation:
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aortic Aneurysm, Thoracic / physiopathology,  surgery*
Blood Vessel Prosthesis Implantation / methods*
Cerebrovascular Circulation
Circulatory Arrest, Deep Hypothermia Induced / methods*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Retrospective Studies
Treatment Outcome
Young Adult
Grant Support
ID/Acronym/Agency:
U01 HL088953/HL/NHLBI NIH HHS
Comments/Corrections

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