Cerebral Protection with Deep Hypothermic Circulatory Arrest during Total Arch Replacement for Acute Aortic Dissection
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0078
Submission Type:
Abstract Submission
Authors:
Yasunori Cho (1), Sohsyu Kotani (2), kimiaki okada (2), Keisuke Ozawa (2), Goro Kishinami (2), Akiyoshi Yamamoto (2), Toshihiko Ueda (2)
Institutions:
(1) Tokai University School of Medicine, Kanagawa, Japan, (2) Tokai University School of Medicine, Kanagawa, Japan
Submitting Author:
Yasunori Cho
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Tokai University School of Medicine
Tokai University School of Medicine
Co-Author(s):
Sohsyu Kotani
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Tokai University School of Medicine
Tokai University School of Medicine
kimiaki okada
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Tokai University School of Medicine
Tokai University School of Medicine
Keisuke Ozawa
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Tokai University School of Medicine
Tokai University School of Medicine
Goro Kishinami
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Tokai University School of Medicine
Tokai University School of Medicine
Akiyoshi Yamamoto
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Tokai University School of Medicine
Tokai University School of Medicine
Toshihiko Ueda
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Tokai University School of Medicine
Tokai University School of Medicine
Presenting Author:
Yasunori Cho
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Tokai University School of Medicine
Tokai University School of Medicine
Abstract:
OBJECTIVE: Stroke after total arch replacement (TAR) remains a serious complication. To prevent it, deep hypothermia has been used during TAR. We evaluate cerebral protection with deep hypothermic circulatory arrest (DHCA) during TAR, particularly for patients with acute aortic dissection (AAD).
METHODS: Between October 2009 and July 2022, 109 consecutive patients with AAD underwent TAR using DHCA on an emergency basis and 147 patients with aneurysm underwent scheduled TAR also using DHCA. We reviewed retrospectively these patients by looking at stroke and 30-day mortality after TAR. We also analyzed the effects of clinical variables and anatomical features on stroke after TAR for AAD.
RESULTS: Stroke after TAR occurred in 11 (10.1%) patients with AAD. The stroke was due to embolism in eight patients, malperfusion in two patients including one who had been in a comatose state, and low output syndrome in one patient. Stroke occurred in 3 (2.0%) patients with aneurysm, due in all three to embolism (P = 0.005). The DHCA time for patients with AAD was 37 ± 7 minutes, and for patients with aneurysm it was 36 ± 6 minutes (P = 0.122). Mortality within 30 days occurred in 10 (9.2%) patients with AAD, and in 2 (1.4%) patients with aneurysm (P = 0.003). In the multivariable analysis, double-barreled dissection in the arch vessels (odds ratio 33.02, confidence interval (4.33 – 252.1), P < 0.001) was the only significant predictor of stroke after TAR for AAD.
CONCLUSIONS: Cerebral protection with DHCA during TAR continues to be an option, particularly for patients with aneurysm. Perioperative stroke in patients undergoing TAR for AAD appears to be associated with air emboli deriving from the double-barreled dissection in the repaired arch vessels.
METHODS: Between October 2009 and July 2022, 109 consecutive patients with AAD underwent TAR using DHCA on an emergency basis and 147 patients with aneurysm underwent scheduled TAR also using DHCA. We reviewed retrospectively these patients by looking at stroke and 30-day mortality after TAR. We also analyzed the effects of clinical variables and anatomical features on stroke after TAR for AAD.
RESULTS: Stroke after TAR occurred in 11 (10.1%) patients with AAD. The stroke was due to embolism in eight patients, malperfusion in two patients including one who had been in a comatose state, and low output syndrome in one patient. Stroke occurred in 3 (2.0%) patients with aneurysm, due in all three to embolism (P = 0.005). The DHCA time for patients with AAD was 37 ± 7 minutes, and for patients with aneurysm it was 36 ± 6 minutes (P = 0.122). Mortality within 30 days occurred in 10 (9.2%) patients with AAD, and in 2 (1.4%) patients with aneurysm (P = 0.003). In the multivariable analysis, double-barreled dissection in the arch vessels (odds ratio 33.02, confidence interval (4.33 – 252.1), P < 0.001) was the only significant predictor of stroke after TAR for AAD.
CONCLUSIONS: Cerebral protection with DHCA during TAR continues to be an option, particularly for patients with aneurysm. Perioperative stroke in patients undergoing TAR for AAD appears to be associated with air emboli deriving from the double-barreled dissection in the repaired arch vessels.
Aortic Symposium:
Cerebral Protection
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