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Revista chilena de cardiología

On-line version ISSN 0718-8560

Abstract

ZALAQUETT, Ricardo; GONZALEZ, Katia; BORCHERT, Evelyn  and  SEPULVEDA, Verónica. Total Replacement of the Ascending Aorta with Moderate Systemic Hypothermic Circulatory Arrest and Retrograde Cerebral Perfusion. Rev Chil Cardiol [online]. 2021, vol.40, n.1, pp.11-19. ISSN 0718-8560.  http://dx.doi.org/10.4067/S0718-85602021000100011.

Background.

Neurological damage is a devastating complication of aortic arch and ascending aorta surgery with deep hypothermic circulatory arrest. Antegrade cerebral perfusion significantly decreases the incidence of this complication, but it is a cumbersome procedure that interfere the surgical field. For more simple procedures, requiring a shorter period of circulatory arrest, retrograde cerebral perfusion (RCP) would be a valid alternative.

Objective.

To evaluate the results of total surgical replacement of the tubular ascending aorta with moderate hypothermic circulatory arrest and retrograde cerebral perfusion (RCP).

Methods.

Patients operated between January 2015 and January 2020 were included.Demographic, clinical and surgical information was obtained from the operatives notes, perfusion registry and discharge reports. Long-term survival was certified by the “Chilean Civil and Identification Registry”.

Results.

27 patients (21 men) underwent a total replacement of the tubular ascending aorta with circulatory arrest with moderate hypothermia and RCP. Eight patients had been previously operated on;7 of them had a previous aortic valve replacement. Of the remaining 20 patients, 75% had a bicuspid aortic valve. Average maximum diameter of the ascending aorta was 53.7 mm (45 - 67). Average size of the ascending aorta replacement graft was 32.4 mm (30 -34). In 20 patients a concomitant aortic valve replacement was performed (15 with a biological valve). Mean extracorporeal circulation time was 174.6 min (97 - 243) and mean minimal systemic temperature was 21ºC (18 - 25). Mean circulatory arrest time was 22.3 min (12 - 40) and mean RCP time was 13 min (6 - 27), There was no operative mortality. Atrial fibrillation was the most frequent post-operative morbidity (33%). One patient presented an isolated convulsive episode and another was re-operated due to postoperative hemorrhage. One patient died, 48 months after her operation.

Conclusion.

Moderate hypothermic circulatory arrest with RCP simplifies total tubular ascending aorta replacement, with low mortality and morbidity.

Keywords : Aortic aneurysm; circulatory arrest; hypothermia; retrograde cerebral perfusion.

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