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Effects of intermittent lower body perfusion on end-organ function during repair of acute DeBakey type I aortic dissection under moderate hypothermic circulatory arrest

Authors
 Suk-Won Song  ;  Kyung-Jong Yoo  ;  Yoo Rim Shin  ;  Sun-Hee Lim  ;  Bum-Koo Cho 
Citation
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, Vol.44(6) : 1070-1075, 2013 
Journal Title
 EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY 
ISSN
 1010-7940 
Issue Date
2013
MeSH
Adult ; Aged ; Aneurysm, Dissecting/surgery* ; Aortic Aneurysm/surgery* ; Blood Vessel Prosthesis Implantation ; Female ; Heart Arrest, Induced/adverse effects ; Heart Arrest, Induced/methods* ; Hospital Mortality ; Humans ; Hypothermia, Induced/adverse effects ; Hypothermia, Induced/methods* ; Male ; Middle Aged ; Postoperative Complications/etiology ; Reperfusion/adverse effects ; Reperfusion/methods ; Retrospective Studies ; Treatment Outcome
Keywords
Aortic dissection ; Circulatory arrest
Abstract
OBJECTIVES: To avoid deep hypothermia-related side effects, moderate hypothermic circulatory arrest (HCA) is commonly employed during aortic arch repair, thereby jeopardizing end-organ protection. We sought to analyse the effect of intermittent lower body perfusion (ILBP) on end-organ function during repair of acute DeBakey type I aortic dissection (AIAD). METHODS: Between May 2008 and May 2011, 107 patients underwent surgical repair for AIAD. All operations were performed with selective cerebral perfusion (SCP) under either moderate HCA only (n = 57) or moderate HCA with ILBP (n = 50). Adverse outcomes, including operative mortality, permanent neurological deficit, temporary neurological deficit, renal failure requiring dialysis and hepatic dysfunction, were compared between the two groups. RESULTS: The mean body temperature at the initiation of SCP was 28.7 ± 1.9 °C. Overall operative mortality occurred in 6 (5.6%) patients. The incidences of permanent neurological deficit and temporary neurological deficit were 1.9 and 4.7%, respectively. None of the 9 (8.4%) patients who suffered postoperative renal failure requiring dialysis received ILBP. The laboratory data showed significantly lower levels of hepatic and kidney enzymes in the ILBP group (P < 0.05). CONCLUSIONS: Significantly lower levels of hepatic and kidney enzymes indicate more effective end-organ protection with the use of ILBP. Our data suggest that ILBP provides more effective end-organ protection during repair of aortic arch under moderate HCA.
Full Text
http://ejcts.oxfordjournals.org/content/44/6/1070.long
DOI
10.1093/ejcts/ezt145
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Thoracic and Cardiovascular Surgery (흉부외과학교실) > 1. Journal Papers
Yonsei Authors
Song, Suk Won(송석원) ORCID logo https://orcid.org/0000-0002-9850-9707
Yoo, Kyung Jong(유경종) ORCID logo https://orcid.org/0000-0002-9858-140X
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/86675
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