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Minimized perfusion circuit for acute type A aortic dissection surgery.

Naoyuki Kimura1, Naoki Momose2, Sho Kusadokoro1

  • 1Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.

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Minimizing perfusion circuits (MPC) in acute type A aortic dissection (ATAAD) surgery showed acceptable outcomes. However, transfusion needs and volume remained high, especially in total arch repair cases.

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Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Minimizing perfusion circuits (MPC) may reduce transfusion requirements and inflammatory responses in cardiovascular surgery.
  • Standardization of MPC use in complex procedures like acute type A aortic dissection (ATAAD) surgery is lacking.

Purpose of the Study:

  • To assess the outcomes of ATAAD surgery using a minimized perfusion circuit (MPC) under circulatory arrest.
  • To compare outcomes between hemiarch and total arch repair in ATAAD patients managed with MPC.

Main Methods:

  • A retrospective study of 706 patients undergoing surgical repair for ATAAD.
  • Patients were treated with either hemiarch repair (n=571) or total arch repair (n=135) using a semi-closed MPC system.
  • Selective antegrade cerebral perfusion was employed for total arch repairs.

Main Results:

  • Overall incidences of shock, organ ischemia, and coagulopathy were 26%, 35%, and 8%, respectively.
  • Total arch repair group showed increased transfusion rates (98% vs. 91%) and volume (1970 vs. 1680 mL) compared to hemiarch repair.
  • No conversions to conventional extracorporeal circulation or MPC-related complications occurred.

Conclusions:

  • Surgery for ATAAD using a minimized perfusion circuit (MPC) yields acceptable clinical outcomes.
  • Despite MPC use, transfusion requirements and volume remain significant, particularly in total arch repair procedures.
  • In-hospital mortality and 10-year survival did not significantly differ between hemiarch and total arch repair groups.