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

Background: The mid-term outcome of quick proximal arch replacement with moderate hypothermia followed by aggressive rapid re-warming in emergency surgery for type A acute aortic dissection (AAD) was assessed.

Methods and Results: Eighty-five patients were divided into 2 groups: group I consisted of 43 patients undergoing surgery for deep hypothermic circulatory arrest and selective cerebral perfusion; and group II consisted of 42 patients who recently underwent aggressive rapid re-warming. During open distal anastomosis in group II patients with a rectal temperature of 28 degrees C but who did not suffer any cerebral perfusion, circulating blood in the cardiopulmonary bypass (CPB) circuit was warmed to 40 degrees C. As soon as distal anastomosis was completed, rapid re-warming was initiated by a 40 degrees C blood perfusion. The duration of CPB (I: 182.1 vs II: 85.3 min), overall operation (305.0 vs 150.8 min), postoperative mechanical ventilation (44.3 vs 9.1 h), and hospital stay (31.4 vs 9.6 days) were significantly shorter in group II patients. The incidence of postoperative brain complication (I: 14.0 vs II: 2.4%), renal failure (14.0 vs 0%), pneumonia (18.6 vs 4.8%), and mortality (9.3 vs 0%) was significantly less in group II patients.

Conclusions: Moderate hypothermia followed by a rapid re-warming procedure was safe and effective in the proximal arch replacement for AAD.