Double arterial perfusion strategy for extensive thoracic aortic surgery to avoid lower body hypothermic circulatory arrest

Czerny, Martin; Mach, Markus; Schönhoff, Florian; Basciani, Reto Marco; Jenni, Hansjoerg; Carrel, Thierry; Schmidli, Jürg (2014). Double arterial perfusion strategy for extensive thoracic aortic surgery to avoid lower body hypothermic circulatory arrest. European journal of cardio-thoracic surgery, 45(3), pp. 460-465. Oxford University Press 10.1093/ejcts/ezt449

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OBJECTIVE To analyse our results of using a double arterial perfusion strategy to avoid lower body hypothermic circulatory arrest after extensive thoracic aortic surgery. METHODS We analysed the intra- and perioperative courses of 10 patients (median age 58 years, median logistic EuroSCORE 14.6) who underwent extensive thoracic aortic surgery with a double arterial perfusion strategy. The main goal of double arterial perfusion is to separate myocardial and supra-aortic from systemic perfusion. Aortic repair starts at the most distal level of the descending aorta, followed by reinsertion of the supra-aortic vessels, and ends with completion of the proximal anastomosis or by any kind of root repair as needed. RESULTS Seven of 10 patients had prior surgery of the thoracic aorta. Indications for surgery were post-dissection aneurysm in 4 patients, true aneurysm in 3, anastomotic aneurysms in 2 and Type B aortic dissection with pseudo-coarctation in 1. Surgical access was performed through median sternotomy with left hemi-clamshell extension in all cases. There was no in-hospital mortality, but perioperative neurological symptoms occurred in 2 patients. These 2 patients developed delayed stroke (after awaking) after an initial uneventful clinical course, and in 1 of them, neurological symptoms resolved completely during follow-up. The median follow-up was 7 (±13) months. There was no death and no need for additional redo surgery during this observational period. CONCLUSIONS Extensive surgery of the thoracic aorta using a double arterial perfusion technique in order to avoid lower body hypothermic circulatory arrest is an attractive option. Further refinements of this technique may enable the safe and effective simultaneous multisegmental treatment of thoracic aortic pathology in patients who would otherwise have to undergo a two-step surgical approach.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Czerny, Martin; Schönhoff, Florian; Basciani, Reto Marco; Jenni, Hansjoerg; Carrel, Thierry and Schmidli, Jürg

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1010-7940

Publisher:

Oxford University Press

Language:

English

Submitter:

Jeannie Wurz

Date Deposited:

29 Sep 2014 14:45

Last Modified:

27 Apr 2018 10:05

Publisher DOI:

10.1093/ejcts/ezt449

PubMed ID:

24031045

Uncontrolled Keywords:

Double arterial perfusion Extensive thoracic aortic surgery Lower body perfusion

BORIS DOI:

10.7892/boris.40973

URI:

https://boris.unibe.ch/id/eprint/40973

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