Hypothermic Circulatory Arrest using Antegrade Cerebral Perfusion is Safe for Elective Aortic Arch Surgery

Background We hypothesized that hypothermic circulatory arrest (HCA) can
be performed with a low operative risk and does not add to the
morbidity in elective procedures.Methods A total of 178 patients with a
mean (± SD) age of 62 (± 10) years underwent HCA for elective aortic
surgery from April 2008 to September 2011. Pre- and postoperative
clinical data were collected prospectively.Results Hemiarch replacement
was performed in 97% patients. Mean logistic Euroscore I was 17% (± 15).
HCA was performed at 26°C bilateral tympanic temperature. Mean HCA
duration was 17 (± 8) min. Mean cross-clamp time was 106 (± 39) min.
Overall 30-day mortality was 2% and stroke occurred in 4% of patients.
Overall 6-month survival was 96%. Cox regression analysis for 6-month
survival revealed four variables with significant influence: the
logistic Euroscore I (p = 0.008), age (p = 0.04), cross-clamp time
(p = 0.008), and reoperation for bleeding complications
(p = 0.04).Conclusions HCA with open distal anastomosis for elective
aortic repair can be performed with low operative mortality, even in the
elderly, and seems not to add to the morbidity of the procedure.