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Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience.
Petar Risteski1, Isabel Radacki1, Andreas Zierer2
1Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
Aorta (Stamford, Conn.)
|October 7, 2021
Summary
Reoperative aortic arch surgery using mild hypothermia and antegrade cerebral perfusion shows favorable outcomes. This approach offers low neurologic complications for complex aortic arch reoperations.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Reoperative aortic arch surgery is complex, with varied indications.
- Previous cardiac surgery increases the challenge of aortic arch reoperations.
Purpose of the Study:
- To assess indications, surgical strategies, and outcomes of reoperative aortic arch surgery.
- Evaluate the safety and efficacy of mild hypothermia and antegrade cerebral perfusion in these procedures.
Main Methods:
- Retrospective analysis of 90 patients undergoing open reoperative aortic arch surgery.
- Procedures utilized repeat sternotomy or clamshell thoracotomy.
- Antegrade cerebral perfusion under mild systemic hypothermia (28.9°C) was standard.
Main Results:
- Operative mortality was 6.7%, with age as the sole predictor.
- Neurologic deficits: 1% permanent, 9% transient.
- 8-year survival was 59%, with heart failure predicting late mortality.
- 8-year freedom from reoperation was 78%.
Conclusions:
- Reoperative aortic arch surgery with antegrade cerebral perfusion and mild hypothermia yields favorable outcomes.
- This technique demonstrates an exceptionally low rate of neurologic morbidity.
- No significant difference in outcomes between hemiarch and complex arch procedures was observed.
