Evaluation of Myocardial Injury, the Need of Vasopressors and Inotropic Support in Beating-Heart Aortic Arch Surgery

Objectives: The 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 selective normothermic myocardial perfusion (SMP) compared with cardioplegic cardiac arrest (CA).

Methods: Total arch replacement was performed in 127 patients (65 [first quartile 56; third quartile 73] years) between March 2013 and May 2018 with the frozen elephant trunk technique. Of those, 25 patients were operated on with selective myocardial perfusion. Blood samples and catecholamine doses were evaluated. Outcomes were compared between the SMP group and the CA group.

Results: Risk factors, the underlying aortic pathologies, and surgical details were similar between the two groups. Intraoperative norepinephrine application rates were significantly lower in the SMP group compared with the CA group (p = 0.030) and postoperative norepinephrine application rates were significantly lower in the SMP group as well (norepinephrine: p = 0.007). Postoperative cardiac enzymes tended to be lower in the SMP group and 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]).

Conclusion: Using selective normothermic myocardial perfusion, beating heart aortic arch surgery has the potential to reduce the perioperative inotropic need and might reduce myocardial injury. The approach has the potential as a useful adjunct to the armamentarium particularly in patients with preexisting myocardial damage or in combination of arch repair plus other complex cardiac procedures.