OBJECTIVE: The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). DESIGN: Retrospective and observational. SETTING: Cardiothoracic operating rooms and intensive care unit. PARTICIPANTS: Seventy-nine consecutive adults undergoing elective proximal aortic arch repair with DHCA (1999-2001). INTERVENTIONS: None. MAIN RESULTS: Average age of the patients was 64.9 years. Mean circulatory arrest time was 30.4 +/- 8.5 minutes. Perioperative mortality was 7.6%. Perioperative stroke incidence was 3.8%. Tracheal extubation was successful in 87.3% of patients within 24 hours of operation. Of the cohort, 80.8% were discharged from the intensive care unit within 72 hours of surgery. Median length of hospital stay was 7.4 days. Repeat mediastinal exploration because of bleeding occurred in 3.8% of patients. Although perioperative renal dysfunction (defined as >1.5-fold increase in plasma creatinine concentration) developed in 24.0% of patients, only 3.8% required dialysis. CONCLUSIONS: The above parameters establish a baseline incidence for major perioperative complications in adults undergoing elective DHCA with RCP for elective proximal aortic arch repair. In approaching the open aortic arch for short periods of circulatory arrest, deep hypothermia with adjunctive RCP is safe and effective.
OBJECTIVE: The purpose of this study was to describe perioperative outcome in adults undergoing elective proximal aortic arch repair with protocol-based deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP). DESIGN: Retrospective and observational. SETTING: Cardiothoracic operating rooms and intensive care unit. PARTICIPANTS: Seventy-nine consecutive adults undergoing elective proximal aortic arch repair with DHCA (1999-2001). INTERVENTIONS: None. MAIN RESULTS: Average age of the patients was 64.9 years. Mean circulatory arrest time was 30.4 +/- 8.5 minutes. Perioperative mortality was 7.6%. Perioperative stroke incidence was 3.8%. Tracheal extubation was successful in 87.3% of patients within 24 hours of operation. Of the cohort, 80.8% were discharged from the intensive care unit within 72 hours of surgery. Median length of hospital stay was 7.4 days. Repeat mediastinal exploration because of bleeding occurred in 3.8% of patients. Although perioperative renal dysfunction (defined as >1.5-fold increase in plasma creatinine concentration) developed in 24.0% of patients, only 3.8% required dialysis. CONCLUSIONS: The above parameters establish a baseline incidence for major perioperative complications in adults undergoing elective DHCA with RCP for elective proximal aortic arch repair. In approaching the open aortic arch for short periods of circulatory arrest, deep hypothermia with adjunctive RCP is safe and effective.
Authors: Sotiris C Stamou; Laura A Rausch; Nicholas T Kouchoukos; Kevin W Lobdell; Kamal Khabbaz; Edward Murphy; Robert C Hagberg Journal: Ann Cardiothorac Surg Date: 2016-07
Authors: Matthew A Schechter; Asad A Shah; Brian R Englum; Judson B Williams; Asvin M Ganapathi; John D Davies; Ian J Welsby; G Chad Hughes Journal: J Crit Care Date: 2015-11-06 Impact factor: 3.425
Authors: Kamrouz Ghadimi; Jacob T Gutsche; Harish Ramakrishna; Samuel L Setegne; Kirk R Jackson; John G Augoustides; E Andrew Ochroch; Stuart J Weiss; Joseph E Bavaria; Albert T Cheung Journal: Ann Card Anaesth Date: 2016 Jul-Sep
Authors: Andreas Habertheuer; Dominik Wiedemann; Alfred Kocher; Guenther Laufer; Prashanth Vallabhajosyula Journal: Biomed Res Int Date: 2015-12-02 Impact factor: 3.411
Authors: William A Kofke; Yue Ren; John G Augoustides; Hongzhe Li; Katherine Nathanson; Robert Siman; Qing Cheng Meng; Weiming Bu; Sukanya Yandrawatthana; Guy Kositratna; Cecilia Kim; Joseph E Bavaria Journal: Front Neurol Date: 2018-06-26 Impact factor: 4.003