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| CIRCULATORY
ARREST IN SURGERY OF THE PROXIMAL AORTA: A PERSONAL EXPERIENCE
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B. Đukanović |
| Dedinje
Cardiovascular Institute, Belgrade, Yugoslavia |
Methods:
During the last five years, a total of 92 patients with diseases
of the proximal aorta were operated in our institution using deep
hypothermic circulatory arrest (DHCA). The group was consisted
of 77 men and 15 women, aged 28 to 72 years. Reasons for surgery
included DeBakey type I and II acute aortic dissection in 37 patients,
chronic dissecting aneurysm in 19 patients, degenerative aneurysm
of the proximal aorta in 35 patients, and couldn't infection in
1 patient. Of these patients, 42 were operated on emergency basis.
In all patients, surgical technique included resection of the
dilated and/or dissected aorta, which was replaced with tubular
grafts. Additionally, there were a total of 87 concomitant procedures
(coronary artery bypass grafting in 26 patients, aortic valve
replacement sec. Bental in 56 patients, aortic valve sparing procedure
in 2 patients, mitral valve replacement in 2 patients, and femoro-femoral
cross-over in 1 patient. REDO procedures were performed in 14
(15,2%) patients. Retrograde perfusion of the brain through superior
vena cava was used in 62 patients. Circulatory arrest occurred
at the temperatures from 15 to 19 degrees centigrade. Results:
Postoperatively, 11 patients died. Death occurred because of myocardial
infraction in 2 patients, respiratory insufficiency and multiple
organ failure in 4 patients, gastrointestinal bleeding in 2 patients,
and heart failure, renal insufficiency and stroke in 1 patient
each. Major postoperative complications were observed in 32 (35%)
patients. Neurological deficit was noticed in only 1 patient who
died as a consequence of stroke. Conclusions: The use of DHCA
allows excellent conditions for complex procedures on proximal
aorta, including REDO procedures, with acceptable early results.
Retrograde perfusion of the brain ameliorates brain protection
and contributes to faster neurological recovery following surgery.
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