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| Format: | Artículo científico |
| Language: | en |
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Sociedade Brasileira de Cirurgia Cardiovascular
2018
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| Online Access: | https://www.redalyc.org/articulo.oa?id=398955542007 https://www.redalyc.org/journal/3989/398955542007/ https://www.redalyc.org/journal/3989/398955542007/html/ https://www.redalyc.org/journal/3989/398955542007/398955542007.epub https://www.redalyc.org/journal/3989/398955542007/movil |
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Table of Contents:
- Predictors of Outcomes after Correction of Acute Type A Aortic Dissection under Moderate Hypothermic Circulatory Arrest and Antegrade Cerebral Perfusion George Samanidis Charalampos Katselis Constantinos Contrafouris Georgios Georgiopoulos Ioannis Kriaras Theofani Antoniou Konstantinos Perreas Medicina Induced Methods Surgery Aneurysm Perfusion Introduction: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.Methods: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. Results: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%.Conclusion: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research. 2018 artículo científico 0102-7638 https://www.redalyc.org/articulo.oa?id=398955542007 https://www.redalyc.org/journal/3989/398955542007/ https://www.redalyc.org/journal/3989/398955542007/html/ https://www.redalyc.org/journal/3989/398955542007/398955542007.epub https://www.redalyc.org/journal/3989/398955542007/movil 10.21470/1678-9741-2017-0123 en http://www.redalyc.org/revista.oa?id=3989 Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery application/pdf Sociedade Brasileira de Cirurgia Cardiovascular Revista Brasileira de Cirurgia Cardiovascular/Brazilian Journal of Cardiovascular Surgery (Brasil) Num.2 Vol.33