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Selective Antegrade Cerebral Perfusion Under Moderate Hypothermia Safe for Aorta Repair: Presented at STS By Charlene Laino FORT LAUDERDALE, Fla -- January 27, 2010 --- In patients undergoing aortic arch surgery, selective antegrade cerebral perfusion in the setting of moderate hypothermic circulatory arrest represents an effective cerebral protective strategy, researchers stated here at the Society of Thoracic Surgeons (STS) 46th Annual Meeting. Performing aortic arch surgery in the setting of moderate hypothermia is safe and offers cerebral protection, said Bradley Leshnower, MD, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia. In his oral presentation on January 26, Dr. Leshnower said that during aortic repair surgery, the body temperature has been traditionally cooled to about 18 degrees Celsius. The purpose is to prevent organ damage once circulatory arrest has been achieved. The researchers reviewed 412 aortic arch procedures involving selective antegrade cerebral perfusion performed between January 2004 and December 2009. A total of 76% of cases were performed electively, and the remaining 24% were emergent type 1 aortic dissections. Of the total, 344 of the procedures were hemi-arch reconstructions and 68 were total-arch replacements. Additionally, 175 of the procedures involved aortic root replacements, with nearly all being valve-sparing. The mean core body temperature at the initiation of selective antegrade cerebral perfusion was 25.7 degrees Celsius, with a range of 19 to 30 degrees Celsius. The average time the patients were in circulatory arrest was 30 minutes. Overall, 7% of patients died, although “mortality was reduced to 4.8% in the latter half of the series as we gained experience with this procedure,” Dr. Leshnower reported. A total of 3.6% of patients suffered a focal stroke, and 5.6% of patients suffered temporary neurological dysfunction. Also, 4.6% of patients developed renal dysfunction requiring dialysis. There were no cases of paraplegia. A subgroup analysis showed that patients who underwent elective surgery had a lower mortality rate: 4.8% versus 14.4% for the emergent cases. “We feel the use of moderate hypothermia with selective antegrade cerebral reperfusion is an effective method of cerebral protection as evidenced by our low rate of permanent and temporary neurologic dysfunction,” Dr. Leshnower concluded. [Presentation title: Moderate Hypothermia With Selective Antegrade Cerebral Perfusion Is Not a Predictor of Adverse Outcome Following Aortic Arch Surgery. Abstract 8] E-mail this page to a friend or colleague! To print, use this version