Fifteen years of surgery for acute type A aortic dissection in moderate-to-mild systemic hypothermia

OBJECTIVE: Surgery for acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurological morbidity and mortality. The following study investigates the clinical results after surgical treatment for acute type A aortic dissection using selective antegrade cerebral perfusion and moderate-to-mild systemic hypothermia (>= 28 degrees C). METHODS: Between January 2000 and January 2015, 453 consecutive patients underwent surgical treatment for acute type A aortic dissection at two aortic referral centres in Germany. Patient mean age was 67 +/- 13 years, 298 patients (66%) were male. Selective unilateral or bilateral cerebral perfusion under moderate-to-mild systemic hypothermia was used in all patients. Ascending aortic replacement, hemiarch replacement and total arch replacement was performed in 9 patients (2%), 342 patients (75%) and 102 patients (23%), respectively. Clinical data were prospectively entered into the institutional databases. Mean late follow-up was 6 +/- 3 years and was 98% complete. RESULTS: Cardiopulmonary bypass time totalled 181 +/- 68 min and the myocardial ischaemic time 107 +/- 43 min. Mean duration of selective antegrade cerebral was 46 +/- 23 min. Mean lowest core temperature amounted to 28.8 +/- 0.6 degrees C. Unilateral cerebral perfusion was performed in 298 patients (66%) and bilateral in 155 patients (34%). Mean intensive care unit stay was 5 +/- 7 days. We observed new postoperative permanent neurological deficits in 27 patients (6%) and transient neurological deficits in 31 patients (7%). Thirty-day mortality was 7% (n = 32). Overall survival rate at 5 years was 77 +/- 6%. CONCLUSIONS: Our data suggest that selective antegrade cerebral perfusion in combination with moderate-to-mild systemic hypothermia (>= 28 degrees C) can be safely and reproducibly applied to surgery for acute type A aortic dissection and offers sufficient neurological and visceral organ protection.