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  • Title: Perioperative outcome in adults undergoing elective deep hypothermic circulatory arrest with retrograde cerebral perfusion in proximal aortic arch repair: evaluation of protocol-based care.
    Author: Appoo JJ, Augoustides JG, Pochettino A, Savino JS, McGarvey ML, Cowie DC, Gambone AJ, Harris H, Cheung AT, Bavaria JE, Improving Clinical Outcomes through Clinical Research Investigators.
    Journal: J Cardiothorac Vasc Anesth; 2006 Feb; 20(1):3-7. PubMed ID: 16458205.
    Abstract:
    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.
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