Right axillary and femoral artery perfusion with mild hypothermia for aortic arch replacement

Objectives: Aortic arch replacement is associated with increased mortality and morbidity especially in acute type-A aortic dissection. Although hypothermic circulatory arrest with selective antegrade cerebral perfusion has been widely used because of its excellent cerebral protection, its optimal perfusion characteristics are unknown. The present study investigates clinical results obtained after perfusion method modification and temperature management during cardiopulmonary bypass (CPB). Methods: Between July 2010 and August 2012, 16 consecutive adult patients (mean age 50.0 yr +/- 14.1 yr, range 25 yr to 73 yr, 12 males, 4 females) who presented with acute Stanford type-A aortic dissection underwent aortic arch replacement (total arch, n = 11; hemiarch, n = 5) under mild hypothermia (31.1 degrees C +/- 1.5 degrees C) with right axillary and femoral artery perfusion. Results: The mean CPB time was 201 min +/- 53 min, and the mean myocardial ischemic time was 140 min +/- 42 min. The mean selective cerebral perfusion time was 80 min +/- 16 min, and the mean lower-body circulatory arrest time was 20 min +/- 13 min. No patient death occurred within 30 post-operative days. The following details were observed: new post-operative permanent neurologic deficit in 1 patient (6.3%), temporary neurologic deficit in 2 patients (12.5%), acute renal dysfunction (creatinine level > 230 umol/L) in 3 patients (18.8%) and mechanical ventilation > 72 h in 5 patients (31.2%). Conclusions: Aortic arch replacement for acute type-A aortic dissection under mild hypothermia with right axillary and femoral artery perfusion could be safely performed in the patient cohort.