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Eur J Cardiothorac Surg 2007;32:263-268. doi:10.1016/j.ejcts.2007.04.035
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Totally normothermic aortic arch replacement without circulatory arrest

Department of Cardiovascular Surgery, Centre Hospitalier et Universitaire d’Amiens, Hôpital Sud, 80054 Amiens Cedex 01, France

Received 14 November 2006; received in revised form 31 March 2007; accepted 5 April 2007.

^_* Corresponding author. Address: Department of Cardiovascular Surgery, Centre Hospitalier et Universitaire d’Amiens, Hôpital Sud, 80054 Amiens Cedex 01, France. Tel.: +33 3 22 45 59 25; fax: +33 3 22 45 53 31. (Email: gtouati.hms{at}invivo.edu).

Background: Various techniques have been proposed for cerebral protection during the surgical treatment of complex aortic disease. The authors propose a revisited strategy of normothermic replacement of the aortic arch to avoid limitations and complications of profound hypothermic circulatory arrest. Materials and methods: From April 2000 to May 2006, 19 patients with an aneurysm of the aortic arch and 10 patients with an acute (7) or a chronic (3) aortic dissection underwent a totally normothermic, complete replacement of the aortic arch using three pumps: One pump ensured antegrade cerebral perfusion, at a flow rate adapted to obtain a pressure of 70 mmHg in the right radial artery, and required a selective cannulation of the supra-aortic vessels. A second pump ensured body perfusion at a flow rate adapted to obtain a pressure of 55 mmHg in the left femoral artery and was situated between the right femoral artery and the right atrium. A special balloon aortic occlusion catheter was placed in the descending thoracic aorta. A third pump ensured intermittent normothermic myocardial perfusion via the coronary venous sinus. The arch reconstruction was performed with no time limit. Results: There were two operative, in-hospital (6.8%) mortalities. All others patients were rapidly extubated, except one, with no neurological sequelae, and postoperative course was uneventful, without coagulopathy or hepato-renal impairment. Conclusions: In the light of these results, a normothermic procedure is possible for arch surgery and may ensure a more physiological autoregulation of cerebral blood flow while maintaining body perfusion without high vascular resistances.

Key Words: Aortic arch • Normothermia • Selective antegrade cerebral perfusion

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