Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia

Abstract

In our experience, ASCP was a safe technique for thoracic aorta surgery allowing complex aortic repairs to be performed with good results in terms of hospital mortality and neurologic outcomes. The fact that there was no difference between the two groups suggests that moderate systemic hypothermia (26 degrees C) appears to be a safe and sufficient tool for brain protection. Moreover, the well known hypothermia-related side effects may be avoided.

Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery

“…27 Furthermore, in recent years, with the use of ACP, deep hypothermia is not deemed necessary for brain protection, and higher temperatures are often used to shorten the CPB time and maintain coagulation. 28 End organs that receive no perfusion during the distal circulatory arrest period potentially suffer from "warm" ischemia injury. 29- 31 We speculate that the combination of a longer procedure time and higher temperature observed in the ACP group could result in poor lung protection, thus possibly leading to postoperative respiratory dysfunction.…”

Open repair techniques in the aortic arch are still superior

“…This was confirmed in some experimental (27) and many studies reporting on a fairly large number of patients in whom the mean duration of the distal circulatory arrest was maintained below 45 minutes, even though those experiences included a fair rate of emergency procedures (28,29).…”

Intraoperative Electroencephalography During Aortic Arch Surgery

“…In addition, the introduction of adjunctive cerebral perfusion techniques, such as retrograde and antegrade cerebral perfusion has allowed continued perfusion and cooling of the brain after systemic circulatory arrest. As a result, a number of institutions have been using a circulatory strategy of more moderate degrees of systemic hypothermia with adjunctive cerebral perfusion in aortic arch operations [28][29][30][31][32][33]. This circulatory strategy, generally called as moderate hypothermic circulatory arrest, has provided comparable or beter surgical outcomes than traditional deep hypothermic circulatory arrest [34,35].…”