Aortic Surgery without Infusion of Cardioplegic Solution at Total Circulatory Arrest

MINIMAL INFUSION OF CARDIOPLEGIC SOLUTION (CPS) DURING AORTIC SURGERY USING TOTAL CIRCULATORY ARREST (TCA) MAY REDUCE SEVERAL POTENTIAL SIDE EFFECTS: clamping on a diseased aorta, insult of coronary ostia, and edema.

From 2006 to 2009, 72 patients underwent aortic surgery without infusion of cardioplegic solution at the initiation of circulatory arrest. The diagnoses were acute aortic dissection (44), aneurysm (22), and intramural hematoma (6).

The duration of TCA, the lowest nasopharyngeal temperature, bypass time, and aortic clamp time was 45 minutes, 16.4℃, 162 minutes, and 100 minutes, respectively. The amount of CPS was 1,050 mL, and 15 patients underwent surgery without CPS. The average inotrope score was 113 points (range, 6.25 to 5,048.5 points) corresponding to the dopamine infusion of 5 mcg/kg/min for 1 day. Seven patients showed a level of creatine kinase-MB above 50 ng/mL, postoperatively, compared with the average of 12.75 ng/mL. The ischemic change was found on electrocardiogram in 5 patients, postoperatively. There was no cardiac morbidity requiring mechanical assist. The average of intensive care unit stay and postoperative hospital stay was 40 hours (range, 15 to 482 hours) and 11 days, respectively.

Minimal infusion of only retrograde CPS during rewarming without initial infusion at TCA in aortic surgery is feasible and can be used with acceptable results.