Clin Res Cardiol 96:Suppl 2 (2007)

P368 - Hypothermic circulatory arrest with selective antegrade cerebral perfusion in aortic arch surgery: a single center experience
 
N. Khaladj1, M. Shrestha1, S. Meck1, S. Peterss1, A. Martens1, M. Winterhalter2, L. Hoy3, A. Haverich1, C. Hagl1
 
1Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Medizinische Hochschule Hannover, Hannover; 2Anästhesiologie, Medizinische Hochschule Hannover, Hannover; 3Biometrie, Medizinische Hochschule Hannover, Hannover;
 
Background: This study was undertaken to identify pre- and intraoperative risk factors influencing outcome after operations requiring hypothermic circulatory arrest (HCA) with selective antegrade cerebral perfusion (SACP) in a single center.
Patients and Methods: Between 11/99 and 03/06, 501 consecutive patients (median age 64 years (20-86), 320 male) underwent aortic arch surgery with moderate HCA (25±2°C) and additional SACP (14°C) at our institution for various indications (256 aneurysms; 153 acute and 23 chronic type A aortic dissections [AADA/CADA]; 66 other).  181 were emergency operations.  Statistical analysis was carried out to determine risk factors for 30-day mortality as well as for temporary (TND) and permanent (PND) neurological dysfunction.
Results: Overall mortality was 11.6%.  48 (9.6%) suffered PND; TND was detected in 67 pts (13.4%).  Multivariate analysis revealed age (p=0.001, Odds Ratio [OR] 1.08); redo surgery (p=0.006, OR 3.58); femoral artery cannulation (p=0.004, OR 2.87), and CPB duration (p<0.001, OR 1.009) as risk factors for mortality.  PND was associated with preoperative renal insufficiency (p=0.029, OR 2.79) and operation time (p<0.001, OR 1.005), whereas TND occurred in patients with coronary artery disease (p=0.04, OR 2.29), emergency surgery (p=0.001, OR 4.09) and increasing HCA duration (p=0.01, OR 1.015).
Conclusions: Moderate HCA in combination with cold SACP is an adequate tool for neuroprotection during aortic arch surgery.  Nevertheless, the safety of this technique is limited in patients with long intraoperative durations, advanced age and multiple co-morbidities.  This technique, which avoids profound core temperatures, has become an alternative to simple deep HCA.
 

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