Moderate Versus Deep Hypothermia With Unilateral Selective Antegrade Cerebral Perfusion for Acute Type A Dissection

Abstract

Moderate HCA with uSACP is an effective circulation management strategy that provides excellent cerebral and visceral protection during emergent ATAAD repair. In the setting of antegrade cerebral perfusion, deep hypothermia does not provide any additional benefit.

Prevention of hemorrhagic complications during operations on the thoracic aorta

“…Таким образом, соблюдение умеренных температурных режимов (25-28° С) у оперируемых пациентов позволяет сократить степень повреждения тромбоцитарного звена и гемостатического статуса в целом. Более того, умеренная гипотермия не сопровождается увеличением неврологических и висцеральных осложнений по сравнению глубокой гипотермией [12]. Дополнительным преимуществом умеренной гипотермии является сокращение времени согревания пациента, что позволяет снизить время искусственного кровообращения, который также признан фактором риска кровотечений [7].…”

Differential aspects of ascending thoracic aortic dissection and its treatment: the North American experience

“…Overall operative mortality reported by North American centers varies from 5% to 17% (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23) and may improve after protocol-based management is implemented and a thoracic aortic team is assembled (30,34). Mortality associated specifically with iatrogenic acute type A dissection has been recently reported as 27% after open surgical repair and up to 33-50% after TEVAR (6)(7)(8).…”

“…Different cannulation strategies have been advocated (19,21,(23)(24)(25)(26)(27). Early application of the crossclamp during the cooling period has been reported (7,23), as has a clampless technique (15)(16)(17)(18)(19). Operative details from North American cardiac surgery centers are shown in Table 1.…”

“…Most North American centers (13)(14)(15)(16)(17)(18)(19)23) tend to favor ascending aorta and hemiarch replacement, with more extensive arch replacement in cases in which the arch is dilated more than 4.5-5 cm or the tear involves the aortic arch. Reportedly, both deep and moderate levels of hypothermia during the period of circulatory arrest have been used successfully (14)(15)(16)(17)22). Different cannulation strategies have been advocated (19,21,(23)(24)(25)(26)(27).…”

“…Major aortic surgery centers have described various extents of surgical repair with hemiarch (i.e., proximal arch) or total arch replacement and different adjuncts for brain protection [antegrade or retrograde cerebral perfusion (RCP)] (13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Most North American centers (13)(14)(15)(16)(17)(18)(19)23) tend to favor ascending aorta and hemiarch replacement, with more extensive arch replacement in cases in which the arch is dilated more than 4.5-5 cm or the tear involves the aortic arch. Reportedly, both deep and moderate levels of hypothermia during the period of circulatory arrest have been used successfully (14)(15)(16)(17)22).…”