Related Experiment Video
Updated: Aug 9, 2025
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Continuous Myocardial Perfusion during Distal Anastomosis of Acute Type A Aortic Dissection
Chia-Yu Ou1, Hsiang-Wei Hu1, Ting-Wei Lin2
1Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Insights
Continuous myocardial perfusion (CMP) during acute type A aortic dissection (ATAAD) surgery reduced heart ischemic time but did not improve cardiac outcomes or mortality compared to cold cardioplegic arrest.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- The efficacy of continuous myocardial perfusion (CMP) in acute type A aortic dissection (ATAAD) surgery is not well-established.
- Investigating CMP's impact on surgical outcomes is crucial for optimizing ATAAD treatment.
Purpose of the Study:
- To evaluate the effect of continuous myocardial perfusion (CMP) during distal anastomosis in acute type A aortic dissection (ATAAD) surgery.
- To compare postoperative morbidity and mortality between CMP and traditional cold cardioplegic arrest (CA) in ATAAD patients.
Main Methods:
- A retrospective review of 141 patients undergoing ATAAD or intramural hematoma surgery from January 2017 to March 2022.
- Patients were divided into CMP (n=51) and cold cardioplegic arrest (CA; n=90) groups, with baseline characteristics balanced using inverse probability of treatment weighting (IPTW).
- Postoperative outcomes, including cardiac enzyme levels, low cardiac output, and mortality, were analyzed.
Main Results:
- CMP significantly reduced median cardiac ischemic time (60.0 vs 130.9 minutes) compared to CA.
- No significant differences were observed in postoperative creatine kinase-MB levels or low cardiac output incidence between CMP and CA groups.
- Surgical mortality rates were comparable between the CMP (15.5%) and CA (7.5%) groups.
Conclusions:
- Continuous myocardial perfusion (CMP) during distal anastomosis in ATAAD surgery effectively reduces myocardial ischemic time.
- CMP does not appear to offer significant benefits in improving cardiac outcomes or reducing mortality in ATAAD patients compared to cold cardioplegic arrest.
- Further research may be needed to fully elucidate the role of CMP in complex aortic surgeries.
Background:
The effect of continuous myocardial perfusion (CMP) on the surgical results of acute type A aortic dissection (ATAAD) remains unclear.
Methods:
From January 2017 to March 2022, 141 patients who underwent ATAAD (90.8%) or intramural hematoma (9.2%) surgery were reviewed. Fifty-one patients (36.2%) received proximal-first aortic reconstruction and CMP during distal anastomosis. Ninety patients (63.8%) underwent distal-first aortic reconstruction and were placed in traditional cold blood cardioplegic arrest (CA; 4°C, 4:1 blood-to-Plegisol) throughout the procedure. The preoperative presentations and intraoperative details were balanced using inverse probability of treatment weighting (IPTW). Their postoperative morbidity and mortality were analyzed.
Results:
The median age was 60 years. The incidence of arch reconstruction in the unweighted data was higher in the CMP compared with the CA group (74.5 vs 52.2%, p = 0.017) but was balanced after IPTW (62.4 vs 58.9%, p = 0.932, standardized mean difference = 0.073). The median cardiac ischemic time was lower in the CMP group (60.0 vs 130.9 minutes, p < 0.001), but cerebral perfusion time and cardiopulmonary bypass time were similar. The CMP group did not demonstrate any benefit in the reduction of the postoperative maximum creatine kinase-MB ratio (4.4 vs 5.1% in CA, p = 0.437) or postoperative low cardiac output (36.6 vs 24.8%, p = 0.237). Surgical mortality was comparable between groups (15.5% in CMP vs 7.5% in the CA group, p = 0.265).
Conclusion:
Application of CMP during distal anastomosis in ATAAD surgery, irrespective of the extent of aortic reconstruction, reduced myocardial ischemic time but did not improve cardiac outcome or mortality.
