Key result
Total arch replacement technique optimizes cerebral protection using SACP, hypothermia, and strict fluid balance.
Why the study?
A detailed description of the preferred surgical technique for total arch replacement using selective antegrade cerebral perfusion is needed to guide clinical practice.
This article details a specific surgical approach for total arch replacement utilizing selective antegrade cerebral perfusion and optimized perioperative management.
Describes a standardized SACP technique for total arch replacement; leaves open the need for comparative outcome trials before wider adoption.
This detailed illustrated article describes our preferred surgical technique of total arch replacement using selective antegrade cerebral perfusion (SACP). Our current approach includes: (I) meticulous selection of arterial cannulation site and type of arterial cannula; (II) SACP for neuro-protection; (III) whole body hypothermia with minimal tympanic temperatures between 20 and 23 °C and minimal rectal temperatures below 30 °C; (IV) early re-warming after distal anastomosis with SACP flow adjustment while monitoring brain oxygenation by near infrared spectroscopy (NIRS); and (V) after 2006, maintaining strict fluid balance below 1 L by the extracorporeal ultrafiltration method (ECUM) during cardiopulmonary bypass (CPB), with the expectation of more rapid pulmonary functional recovery.
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Okita et al. (2013) studied Aortic arch disease requiring total arch replacement. Total arch replacement using selective antegrade cerebral perfusion (SACP) was evaluated. This article describes a preferred surgical technique for total arch replacement using selective antegrade cerebral perfusion, hypothermia, and strict fluid balance.
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