Perioperative Outcome in Adults Undergoing Elective Deep Hypothermic Circulatory Arrest With Retrograde Cerebral Perfusion in Proximal Aortic Arch Repair: Evaluation of Protocol-Based Care

Appoo, Jehangir J.; Augoustides, John G.; Pochettino, Alberto; Savino, Joseph S.; McGarvey, Michael L.; Cowie, Doreen C.; Gambone, Andrew J.; Harris, Hilary; Cheung, Albert T.; Bavaria, Joseph E.; Improving Clinical Outcomes through Clinical Research (ICOR) Investigators,

doi:10.1053/j.jvca.2005.08.005

« Previous Next »Journal of Cardiothoracic and Vascular Anesthesia
Volume 20, Issue 1 , Pages 3-7, February 2006

Perioperative Outcome in Adults Undergoing Elective Deep Hypothermic Circulatory Arrest With Retrograde Cerebral Perfusion in Proximal Aortic Arch Repair: Evaluation of Protocol-Based Care

Jehangir J. Appoo, MD
- Department of Surgery, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
John G. Augoustides, MD
- Department of Anesthesia, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
- Address reprint requests to John G. Augoustides, MD, Department of Anesthesia, 680 Dulles, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104-4283
Alberto Pochettino, MD
- Department of Surgery, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
Joseph S. Savino, MD
- Department of Anesthesia, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
Michael L. McGarvey, MD
- Department of Neurology, Hospital of the University of Pennsylvania, Philadelphia, PA
Doreen C. Cowie, CCP
- Department of Clinical Perfusion, Hospital of the University of Pennsylvania, Philadelphia, PA
Andrew J. Gambone, BA
- Department of Anesthesia, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
Hilary Harris, BA
- Department of Anesthesia, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
Albert T. Cheung, MD
- Department of Anesthesia, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
Joseph E. Bavaria, MD
- Department of Surgery, Cardiothoracic Division, Hospital of the University of Pennsylvania, Philadelphia, PA
Improving Clinical Outcomes through Clinical Research (ICOR) Investigators

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.

Key words: deep hypothermic circulatory arrest , perioperative outcome , retrograde cerebral perfusion , stroke