Contact Admin. Surgical treatment of the ascending aorta and aortic arch with antegrade cerebral perfusion and moderate hypothermia. Twelve consecutive adult patients who presented with proximal aortic dissections or aneurysms were operated on. Of these, seven presented with aortic dissections and five presented with ascending aortic or aortic arch aneurysms.
Arterial perfusion was achieved using an 8. There were no neurological or bleeding complications. In ten cases, the aortic valve was preserved by resuspension or remodeling. The mean time of circulatory arrest with antegrade cerebral perfusion was 24 minutes range from 20 to 35 minutes. Thoracic aortic diseases present with significant morbidity and mortality rates and are considered the most complex aortic diseases, causing severe consequences when treatment is not performed in time or when it is inadequate.
There have been great advances in the treatment of these diseases with the evolution of imaging techniques, bringing substantial improvements to surgical results and consequently, survival of patients. In DeBakey et al. These authors described the excision of the dilated section, joining of the separated layers and restoration of the aortic blood flow with an end-to-end anastomosis. The procedure was accompanied by a high morbimortality rate until the s.
Ischemic injury to the central nervous system and uncontrollable perioperative hemorrhages constitute the main causes for the high death rates [3]. A great advance was the introduction by Griepp et al. Cardiac arrest with deep hypothermia provides a bloodless, motionless operative field. Deep hypothermia protects the brain, the heart, the kidneys and other organs, presumably due to a reduction in the metabolic activity.
However, clinical experience indicates that the time of cardiac arrest is important. The risk of neurological dysfunction increases significantly after 40 to 50 minutes and mortality increases greatly after 65 minutes of cardiac arrest [5].
