Thorac Cardiovasc Surg 2001; 49(5): 283-286
DOI: 10.1055/s-2001-17806
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

Aortic Arch Surgery using Moderate Systemic Hypothermia and Antegrade Cerebral Perfusion via the Right Subclavian Artery*

H. Aebert, D. Reber, R. Kobuch, A. Philipp, D. E. Birnbaum
  • Department of Thoracic and Cardiovascular Surgery, Regensburg University Hospital, Regensburg, Germany
Further Information

Publication History

Publication Date:
15 October 2001 (online)

Background: Surgery of the aortic arch avoiding profound systemic hypothermia and using antegrade or retrograde cerebral perfusion has recently been popularized. This usually renders the CPB and surgical field set-up more complex. We propose a simple method achieving a similar effect. Methods: During a 6-month period, 7 patients (median age 72 years) underwent surgery involving the aortic arch with cannulation of the right subclavian artery for arterial return. There were 6 acute type A dissections and one ascending aorta and arch aneurysm. After commencing CPB, the ascending aorta was clamped and reconstruction of aortic valve and root were initiated. Patients were cooled to a tympanic temperature of 25 - 27 °C. CPB was then stopped, and the arch was opened and inspected from inside. While resuming arterial perfusion via the right subclavian artery, the arch branches were clamped sequentially from right to left under observation for back flow. Bilateral radial artery pressure and temporal transcutaneous oxygen saturation were always monitored. Results: In all cases, the aortic valve was spared using remodeling and resuspension techniques. 2 complete arch, 2 partial arch and 3 proximal arch replacements were performed. Mean times were 183 (113 - 321) minutes for CPB and 120 (67 - 213) minutes for aortic cross-clamping. Maximal systemic circulatory arrest time was 82 min. One patient died in the hospital due to MRSA sepsis with a normal CCT scan. All others were discharged in good condition. Conclusion: The initial experience with this simple technique of antegrade cerebral perfusion avoiding profound systemic hypothermia and the possible disadvantages of femoral artery cannulation appears promising.

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1 Presented at the 3rd Joint Meeting of the German, the Austrian and the Swiss Societies for Thoracic and Cardiovascular Surgery, Luzern, Switzerland, February 9-12, 2000

PD Dr. H. Aebert

Department of Thoracic and Cardiovascular Surgery
Eberhard-Karls-Universität Tübingen

Hoppe-Seyler-Straße 3

72076 Tübingen

Germany

Phone: +49 (7071) 2986638

Fax: +49 (7071) 294047

Email: hermann.aebert@med.uni-tuebingen.de

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