P078. Cerebral Protection with Deep Hypothermic Circulatory Arrest during Total Arch Replacement for Acute Aortic Dissection
Tokai University School of Medicine
Kanagawa
Japan - Contact Me
Name: Yasunori Cho
Official Position: Professor and Chairman
Department of Cardiovascular Surgery Tokai University School of Medicine
Current Address: 143, Shimokasuya, Isehara, Kanagawa 259-1193, JAPAN
TEL: +81-463-93-1121 FAX: +81-463-93-3806
Education (University): March 1990: Keio University School of Medicine
Academic Appointments
May 1990: Resident, General Surgery, Keio University Hospital
May 1993: Resident, Department of Cardiovascular Surgery, Keio University School of Medicine
May 1996: Chief resident, Department of Cardiovascular Surgery, Keio University School of Medicine
May 1998: Attending Surgeon, Department of Cardiovascular Surgery, Hiratsuka city Hospital
Nov 2000: Clinical fellow, Centre de Cardio-Thoracique de Monaco
May 2004: Chief Surgeon, Department of Cardiovascular Surgery, Hiratsuka city Hospital
Oct 2009: Associate Professor, Department of Cardiovascular Surgery, Tokai University School of Medicine
Apr 2015: Professor, Department of Cardiovascular Surgery, Tokai University School of Medicine
Apr 2019: Professor and Chairman, Department of Cardiovascular Surgery, Tokai University School of Medicine
Licensure: 1990- Japan (#332706)
Academic Society Certifications:
Board certified surgeon (December 2004)
Board certified cardiovascular surgeon (April 2004)
Board certified surgeon/ trainer of Japan Surgical Society (December 2005)
Board certified surgeon/ trainer of The Japanese Association for Thoracic Surgery (August 2005)
Clinical training manager (Cardiovascular surgery; January 2007)
Membership of Academic Societies:
Japan Surgical Society (Councilor, 2020-)
The Japanese Association for Thoracic Surgery (Councilor, 2018-)
The Japanese Society for Cardiovascular Surgery (Councilor, 2018-)
Society of Thoracic Surgeons (International member)
European Association of Cardio-thoracic Surgery (Active member)
Asian Society for Cardiovascular and Thoracic Surgery
Description
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.
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