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|Title:||Outcomes of total arch replacement with stepwise distal anastomosis technique and modified perfusion strategy|
|Authors:||Matsuyama, Shigefumi;Tabata, Minoru;Shimokawa, Tomoki;Matsushita, Akihito;Fukui, Toshihiro;Takanashi, Shuichiro|
|Publisher:||The American Association for Thoracic Surgery|
|Abstract:||Objective: Total arch replacement has been reported to present high morbidity and mortality. We have introduced a stepwise distal anastomosis technique and modified perfusion strategy, including selective antegrade cerebral perfusion, moderate hypothermia, and separate lower-body perfusion, to minimize organ ischemia and secondary morbidities. We report the operative outcomes of total arch replacement with our modified perfusion strategy. Methods: Between August 2006 and December 2008, 119 patients underwent total arch replacement with the current perfusion strategy. Of these patients, 56 (47%) underwent emergency operation for acute type A aortic dissection (n = 48) or ruptured thoracic aneurysm (n = 8). The mean age of patients was 68 years, and the mean follow-up period was 25 months. We analyzed operative mortality, morbidity, and 4-year survival of this patient group. Results: The mean operation, cardiopulmonary bypass, and circulatory arrest times were 313, 183, and 47 minutes, respectively. Operative mortality was 3.4%. Operative mortality of elective cases was 1.6%. The incidences of permanent neurologic deficit, paraparesis, and renal insufficiency were 5.0%, 1.7%, and 7.6%, respectively. Actuarial 4-year survival was 86.5%. Conclusions: Total arch replacement with our modified perfusion strategy has demonstrated low operative mortality and morbidity. Copyright ?? 2012 by The American Association for Thoracic Surgery.|
|More Information:||VOLUME : 143ISSUE : 6START PAGE : 1377|
END PAGES : 1381
|Appears in Collections:||Journal of the thoracis and cardiovascular surgery|
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