Whole-body perfusion under moderate-degree hypothermia during aortic arch repair

There continue to be some controversies concerning aortic arch reconstruction, especially the cerebral protection methods. We report our operative and postoperative outcomes for cases of aortic arch replacement using whole-body perfusion during aortic reconstruction under 28 degrees C moderate hypothermia.

A total of 12 patients were operated on between March 2003 and November 2005. Two of the patients were female. The mean age of the patients was 53.5 x 7.3 years (range, 42-65 years). We cannulated the right axillary artery for cerebral perfusion and the right femoral artery for body perfusion. Arch replacement was done under continuous antegrade cerebral perfusion through the right axillary artery and continuous body perfusion through the right femoral artery via intra-aortic occlusion of the proximal descending aorta with an intra-aortic occlusion catheter. Perioperative data and postoperative outcomes, blood urea nitrogen, serum creatinine, and alanin aminotransferase values were evaluated retrospectively in the patients.

There was only 1 hospital mortality. There were no neurologic complications. Postoperative levels of blood urea nitrogen and creatinin did not show significant difference but the alanin aminotransferase levels were significantly higher in the postoperative period, which was within the normal ranges of cardiopulmonary bypass effect.

Whole-body perfusion through the axillary and femoral arteries may provide more time for the surgeon and good cerebral and visceral protection, which are especially important for surgical teams in the learning curve.