Key result
Mild hypothermic ASCP yields similar mortality to moderate ASCP and deep RCP but reduces ICU stay.
Why the study?
Hypothermia during systemic circulatory arrest in aortic surgery can lead to various problems, motivating evaluation of ASCP with mild hypothermic systemic arrest.
Does antegrade selective cerebral perfusion with mild hypothermic systemic arrest improve outcomes compared to moderate hypothermic ASCP or deep hypothermic RCP in patients undergoing thoracic aortic surgery?
Cohort (n=68)
Does antegrade selective cerebral perfusion with mild hypothermic systemic arrest improve outcomes compared to moderate hypothermic ASCP or deep hypothermic RCP in patients undergoing thoracic aortic surgery?
Mild hypothermic ASCP during thoracic aortic surgery offers comparable safety to moderate or deep hypothermia while reducing resource utilization such as transfusion volume and ICU stay.
Mild hypothermic ASCP was associated with shorter ICU stays and similar safety in this cohort; leaves open confirmation versus moderate/deep strategies in randomized trials.
OBJECTIVE: Antegrade selective cerebral perfusion (ASCP) and retrograde cerebral perfusion (RCP) have proven to be reliable methods of brain protection during aortic surgery. These techniques are usually accompanied by systemic circulatory arrest with moderate hypothermia (24-28 degrees C) or deep hypothermia (18-24 degrees C). However, hypothermia can lead to various problems. The present study therefore reports results for thoracic aorta replacement using ASCP with mild hypothermic systemic arrest (28-32 degrees C). DESIGN: Between 1995 and 2003, 68 consecutive patients underwent repair of the ascending aorta and/or aortic arch. Mild hypothermic ASCP was utilized in 31 cases, moderate hypothermic ASCP in 20, and deep hypothermic RCP in 17. Various parameters were compared between the mild hypothermic ASCP, moderate hypothermic ASCP, and RCP. RESULTS: Hospital mortality was 10.3%, with no significant differences observed between any groups. Permanent neurological dysfunction was 8.8%, and no significant differences were observed between any groups. Mild hypothermic ASCP displayed significantly decreased transfusion volume, intubation time, and ICU stay. CONCLUSIONS: Use of ASCP with mild hypothermic systemic circulatory arrest during aortic surgery resulted in acceptable hospital mortality and neurological outcomes. ASCP with mild hypothermic arrest allows decreased transfusion volume and reduced duration of intubation and ICU stay.
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Kaneda et al. (2005) conducted a cohort in Thoracic aortic surgery (n=68). Antegrade selective cerebral perfusion with mild hypothermic systemic arrest vs. Moderate hypothermic ASCP and deep hypothermic RCP was evaluated on Hospital mortality. ASCP with mild hypothermic arrest during aortic surgery yielded similar overall hospital mortality (10.3%) and neurological dysfunction (8.8%) to moderate ASCP and deep RCP, but reduced ICU stay.
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