Tim Berger1,2, Maximilian Kreibich3,4, Bartosz Rylski3,4, Julia Morlock3,4, Stoyan Kondov3,4, Johannes Scheumann3,4, Fabian A Kari3,4,5, Klaus Staier6,4, Sven Maier3,4, Friedhelm Beyersdorf3,4, Martin Czerny3,4, Matthias Siepe3,4. 1. Department of Cardiovascular Surgery, University Heart Centre, Freiburg University, Freiburg, Germany - tim.berger@universitaets-herzzentrum.de. 2. Faculty of Medicine, University of Freiburg, Freiburg, Germany - tim.berger@universitaets-herzzentrum.de. 3. Department of Cardiovascular Surgery, University Heart Centre, Freiburg University, Freiburg, Germany. 4. Faculty of Medicine, University of Freiburg, Freiburg, Germany. 5. Pediatric Cardiac Surgery, New York Presbyterian/Columbia University Medical Centre, Morgen Stanley Children ́s Hospital, New York, NY, USA. 6. Department of Anesthesiology, Heart Centre Freiburg University, Bad Krozingen, Germany.
Abstract
BACKGROUND: In contrast to the standard cardioplegic cardiac arrest (CA), some centers prefer the beating-heart technique using selective normothermic myocardial perfusion (SMP) during aortic arch repair. Aim of this study was to evaluate myocardial injury and the need for inotropic and vasopressor support in patients undergoing total aortic arch replacement using SMP or CA during arch repair. METHODS: Total arch replacement was performed in 127 patients (65 first quartile 56; third quartile 73 years) between March 2013 and May 2018 via the frozen elephant trunk technique. Of those, 25 patients were operated on with selective myocardial perfusion. Blood samples and catecholamine doses were evaluated. We compared the SMP group's and CA group's outcomes. RESULTS: The two groups' risk factors, underlying aortic pathologies, and surgical details were similar. The SMP group's intraoperative norepinephrine application rates were significantly lower than the CA group's (p=0.030), as were their postoperative norepinephrine application rates (norepinephrine: p=0.007). Postoperative cardiac enzymes tended to be lower in the SMP group; the difference in creatine-kinase MB reached statistical significance after 14 hours (p=0.024). Intensive care unit stay was significantly shorter in the SMP group (p=0.041), and in-hospital mortality was comparable [4% in the SMP and 11% in the CA group (p=0.46)]. CONCLUSIONS: By applying selective normothermic myocardial perfusion, beating-heart aortic arch surgery has the potential to reduce the need for perioperative inotrops, and it might reduce myocardial injury. This approach is a potentially useful adjunct to our armamentarium, particularly in patients with preexisting myocardial damage or in conjunction of arch repair together with other cardiac procedures.
BACKGROUND: In contrast to the standard cardioplegic cardiac arrest (CA), some centers prefer the beating-heart technique using selective normothermic myocardial perfusion (SMP) during aortic arch repair. Aim of this study was to evaluate myocardial injury and the need for inotropic and vasopressor support in patients undergoing total aortic arch replacement using SMP or CA during arch repair. METHODS: Total arch replacement was performed in 127 patients (65 first quartile 56; third quartile 73 years) between March 2013 and May 2018 via the frozen elephant trunk technique. Of those, 25 patients were operated on with selective myocardial perfusion. Blood samples and catecholamine doses were evaluated. We compared the SMP group's and CA group's outcomes. RESULTS: The two groups' risk factors, underlying aortic pathologies, and surgical details were similar. The SMP group's intraoperative norepinephrine application rates were significantly lower than the CA group's (p=0.030), as were their postoperative norepinephrine application rates (norepinephrine: p=0.007). Postoperative cardiac enzymes tended to be lower in the SMP group; the difference in creatine-kinase MB reached statistical significance after 14 hours (p=0.024). Intensive care unit stay was significantly shorter in the SMP group (p=0.041), and in-hospital mortality was comparable [4% in the SMP and 11% in the CA group (p=0.46)]. CONCLUSIONS: By applying selective normothermic myocardial perfusion, beating-heart aortic arch surgery has the potential to reduce the need for perioperative inotrops, and it might reduce myocardial injury. This approach is a potentially useful adjunct to our armamentarium, particularly in patients with preexisting myocardial damage or in conjunction of arch repair together with other cardiac procedures.
Authors: Maximilian Kreibich; Tim Berger; Tim Walter; Paul Potratz; Philipp Discher; Stoyan Kondov; Friedhelm Beyersdorf; Matthias Siepe; Roman Gottardi; Martin Czerny; Bartosz Rylski Journal: Cardiovasc Diagn Ther Date: 2022-06
Authors: Tim Berger; Miriam Graap; Bartosz Rylski; Albi Fagu; Roman Gottardi; Tim Walter; Philipp Discher; Muhammad Taha Hagar; Stoyan Kondov; Martin Czerny; Maximilian Kreibich Journal: Front Cardiovasc Med Date: 2022-06-06
Authors: Tim Walter; Tim Berger; Stoyan Kondov; Roman Gottardi; Julia Benk; Bartosz Rylski; Martin Czerny; Maximilian Kreibich Journal: Front Cardiovasc Med Date: 2022-06-30