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General Thoracic and Cardiovascular Surgery
Published in: General Thoracic and Cardiovascular Surgery 10/2022

13-04-2022 | Circulatory Arrest | Original Article

Safety of retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement

Authors: Yoshinori Nakahara, Yusuke Tsukioka, Retsu Tateishi, Shunya Ono, Masato Shioya, Yoshifumi Itoda, Takeyuki Kanemura

Published in: General Thoracic and Cardiovascular Surgery | Issue 10/2022

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Abstract

Objectives

Aortic surgeries performed under moderate hypothermia require antegrade cerebral perfusion. The influence of retrograde cerebral perfusion under moderate hypothermic circulatory arrest remains unknown. To clarify this effect, this study aimed to compare the early outcomes of retrograde versus antegrade cerebral perfusion under moderate hypothermia for hemiarch replacement.

Methods

Between March 2009 and April 2020, 391 hemiarch replacements under moderate hypothermic circulatory arrest via median sternotomy were performed at our institution. Of these, 70 involved retrograde perfusion and 162 involved antegrade perfusion. Propensity score matching was used to compare 61 pairs of retrograde and antegrade cases.

Results

Retrograde and antegrade strategy under moderate hypothermia resulted in comparable operative mortality (3.3% vs. 1.6%, P > 0.99), permanent neurological deficits (8.5% vs. 6.6%, P > 0.99), and temporary neurological deficits (24.6% vs. 39.3%, P = 0.33). Retrograde surgery was associated with shorter circulatory arrest times (31.4 ± 8.2 min vs. 37.4 ± 12.2 min, P = 0.005) and fewer red blood cell transfusions (4.6 ± 3.9 units vs. 8.2 ± 5.1 units, P < 0.001) than those with antegrade surgery.

Conclusions

Retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement yields excellent operative outcomes, equivalent to those achieved using an antegrade strategy.
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Metadata
Title
Safety of retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement
Authors
Yoshinori Nakahara
Yusuke Tsukioka
Retsu Tateishi
Shunya Ono
Masato Shioya
Yoshifumi Itoda
Takeyuki Kanemura
Publication date
13-04-2022
Publisher
Springer Nature Singapore
Published in
General Thoracic and Cardiovascular Surgery / Issue 10/2022
Print ISSN: 1863-6705
Electronic ISSN: 1863-6713
DOI
https://doi.org/10.1007/s11748-022-01814-6

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