Quick Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest

Kamiya, Hiroyuki; Hagl, Christian; Kropivnitskaya, Irina; Weidemann, Juergen; Kallenbach, Klaus; Khaladj, Nawid; Haverich, Axel; Kretzler, Matthias

doi:10.1016/j.athoracsur.2006.09.085

Cited by 24 publications

(9 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…4 Kamiya and colleagues have reported their own quick proximal arch replacement technique, in which the distal anastomosis is performed under moderate hypothermia of 26°-28°C without any cerebral perfusion. 5 The CPB and total operative times in their procedure were about 130 and 240 min, respectively. 5 These times are much longer than those in our LIQR, in which the distal anastomosis is also performed under moderate hypothermic (28°C) circulatory arrest without any cerebral perfusion; however, the CPB and total operative times are about 70 and 130 min, respectively.…”

Section: Discussionmentioning

confidence: 99%

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

et al. 2009

View full text Add to dashboard Cite

We describe a newly modified technique, which we term "less invasive quick replacement" (LIQR) for type A acute aortic dissection (AAD). After cooling to a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed up to 40 degrees C during open distal anastomosis. As soon as the distal anastomosis was completed, rapid rewarming was initiated by perfusing blood at 40 degrees C. The average CPB and total operative times were 71.8 +/- 9.6 and 130.6 +/- 7.7 min, respectively. The shortest operative time was 101 min from skin incision to skin closure. All patients were weaned off the ventilator within 12 h of surgery. The postoperative hospital stay was 9.3 +/- 1.2 days. There was no incidence of cerebral damage or hospital mortality. Our initial results showed LIQR to be safe and effective.

show abstract

Section: Discussionmentioning

confidence: 99%

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

et al. 2009

View full text Add to dashboard Cite

show abstract

“…Although it took approximately 20 min to complete the distal anastomosis, the durations for CPB and overall operation were approximately 85 and 150 min, respectively, which was much quicker than those of previous reports. 3 The shortest operation time in our study was 101 min from skinto-skin. In general, quicker is not always better.…”

Section: Discussionmentioning

confidence: 99%

“…2 Recently, it has been reported that moderate hypothermic arrest at 26-28°C without any adjunctive cerebral protection was safe in patients undergoing hemiarch aortic replacement. 3 We have established a new procedure for proximal arch replacement for patients with moderate hypothermic arrest without cerebral perfusion, which is followed by aggressive rapid re-warming to shorten the duration of brain ischemia, CPB, and overall surgery. We report here on the initial results of this procedure for an octogenarian with AAD 4 and have since performed this procedure for all the patients undergoing an emergency proximal arch replacement for AAD.…”

mentioning

confidence: 99%

Outcome of Less Invasive Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest Followed by Aggressive Rapid Re-Warming in Emergency Surgery for Type A Acute Aortic Dissection

Hata

Suzuki

Sezai

et al. 2009

Circ J

View full text Add to dashboard Cite

Circ J 2009; 73: 69 -72 urgical mortality rates during emergency operation for type A acute aortic dissection (AAD) are still estimated to range from 9 to 30%, and is associated with postoperative complications such as cerebral injury, bleeding, renal failure, and pneumonia caused by longer operation time (>6 h), longer cardiopulmonary bypass (CPB) time (>4 h), deep hypothermia, and circulatory arrest (DHA). 1 If surgical stress could be minimized by shortening the duration of brain ischemic stress, CPB and operative procedures, the surgical outcome for patients with AAD could be further improved. In the majority of patients, an ascending or hemiarch replacement is sufficient, as the intimal tear is generally located in the ascending or the proximal aortic arch. 2 Recently, it has been reported that moderate hypothermic arrest at 26-28°C without any adjunctive cerebral protection was safe in patients undergoing hemiarch aortic replacement. 3 We have established a new procedure for proximal arch replacement for patients with moderate hypothermic arrest without cerebral perfusion, which is followed by aggressive rapid re-warming to shorten the duration of brain ischemia, CPB, and overall surgery. We report here on the initial results of this procedure for an octogenarian with AAD 4 and have since performed this procedure for all the patients undergoing an emergency proximal arch replacement for AAD. The aim of this study is to assess the mid-term outcome of our newly modified technique. MethodsBetween March 2002 and February 2008, 114 patients underwent emergency surgery for AAD at our institution. The extent of aortic replacement was decided based on the location of the intimal tear (tear-oriented surgery). Ascending/hemiarch aortic replacement was performed in patients with the intimal tear localized in the ascending aorta or in the lesser curvature of the transverse aortic arch proximal to the left subclavian artery. In this series, 85 (74.6%) consecutive patients underwent ascending/hemiarch aortic replacement. We retrospectively reviewed these patients. Institutional review board approval was provided before publication of this manuscript and reporting of the information. Fifty patients (58.8%) were female, and the average age was 66.9±12.0 years, ranging from 36 to 90 years.

show abstract

“…There is controversy about no cerebral perfusion during circulatory arrest for safe brain protection. In the present decade, however, several groups have successively reported the safety and effectiveness of deep hypothermic circulatory arrest alone without cerebral perfusion [7]. There is no common guideline on brain protection during circulatory arrest.…”

Section: Regarding Lack Of Cerebral Perfusionmentioning

confidence: 99%

Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

Suzuki

Asai

Kinoshita

2019

The Annals of Thoracic Surgery

View full text Add to dashboard Cite

Background. Octogenarians are often declined an emergency operation for acute type A aortic dissection on grounds of high mortality rate and short life expectancy. Our policy is to accept all patients at any time and never to refuse an emergency operation, even for octogenarians. Methods. From April 2004 to September 2017, 319 patients underwent surgical repair for acute type A aortic dissection at our institution. We compared the clinical results between the 55 elderly patients (‡80 years old; older group) and the 264 nonelderly patients (£79 years old; younger group). The primary end point was early mortality, and the secondary end point was long-term mortality. Results. The older group had a higher proportion of women (74.5% vs 46.6%), a lower body mass index (21.4 vs 23.8 kg/m 2), and a lower proportion of smokers Operative Technique The operation was performed through a median sternotomy in all patients. Our detailed surgical procedures

show abstract

Quick Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest

Cited by 24 publications

References 6 publications

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

Less invasive quick replacement of the proximal arch with aggressive rapid rewarming for type A acute aortic dissection

Outcome of Less Invasive Proximal Arch Replacement With Moderate Hypothermic Circulatory Arrest Followed by Aggressive Rapid Re-Warming in Emergency Surgery for Type A Acute Aortic Dissection

Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

Contact Info

Product

Resources

About