Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest

Abstract

Aortic surgery with DHCA can be performed with favorable late survival, with the duration of DHCA period having only a limited impact. However, these results cannot be generalized for very long durations of DHCA (>50 minutes), when perfusion methods may be preferable. In elective, nondissection first-time surgeries, a late survival comparable to that in a reference population can be achieved. Early survival is adversely affected by aortic dissection, redo status, and disease extent.

The effects of ATP on the contractions of rat and mouse fast skeletal muscle

“…Therapeutic hypothermia is used to treat patients experiencing out of hospital cardiac arrest, during pediatric resuscitation, and is commonly used during cardiac surgical procedures (as a means of cerebral protection) involving interruption of blood flow to the brain . Physiologic effects of hypothermia are manifold, including a significant reduction in the tissue's metabolic rate for oxygen and glucose . Although the effects of hypothermia have been well‐established clinically, the mechanisms of its action remain elusive in many tissues, and specifically in skeletal muscles.…”

“…16 Physiologic effects of hypothermia are manifold, including a significant reduction in the tissue's metabolic rate for oxygen and glucose. 17,18 Although the effects of hypothermia have been well-established clinically, the mechanisms of its action remain elusive in many tissues, and specifically in skeletal muscles.…”

Protecting the brain and spinal cord in aortic arch surgery

“…Figure 1 is based on a study (1) conducted many years ago on Dr. Stanley Crawford's patients, which showed that after 40 minutes of circulatory arrest, but with deep hypothermia alone, the risk of stroke increased. More recent studies support that 40 minutes of circulatory arrest is the maximum (2). If a procedure can be completed in less than 25-30 minutes, with hypothermia less than 20 ℃ on nasopharyngeal measurement, then this can be safely done.…”

Straight deep hypothermic circulatory arrest for aortic arch surgery: Going the way of the dinosaurs?

“…In this issue of the Journal, Damberg and colleagues 1 report their experience with straight deep hypothermic circulatory arrest (DHCA) as the sole means of brain protection during operations on the aortic arch in 613 consecutive patients, focusing on late outcomes. 1 The independent variables associated with increased 1-year mortality were acute type A aortic dissection, reoperative status, and the presence of descending thoracic aortic pathology. The independent variables associated with increased mortality beyond 1 year were increased age, postoperative complications (stroke, dialysis, pulmonary complications), and postoperative atrial fibrillation.…”