Zone 2 Aortic Arch Replacement with Deep Hypothermic Circulatory Arrest Followed by Antegrade Cerebral Perfusion is a Safe Technique for Aortic Arch Reconstruction
Tyler J. Wallen1, Etzer Augustin2, Eric Jeng2, Tomas Martin2, Thomas Beaver2, Kirsten Freeman2, George Arnaoutakis2.
1Geisinger Health System, Wilkes-Barre, PA, USA, 2University of Florida, Gainesville, FL, USA.
Background: Zone 2 aortic arch replacement simplifies the arch reconstruction in both acute and chronic pathologies. This technique creates a durable landing zone for a TEVAR. We report our experience of zone 2 aortic arch reconstruction utilizing a period of deep hypothermic circulatory arrest (DHCA) followed by antegrade cerebral perfusion (ACP).
Methods: A retrospective review of a prospectively maintained database was performed from 2018-2020. Patients were cooled to 18o C for DHCA and the innominate and left common carotid arteries were debranched, followed by distal aortic reconstruction (Figure 1). Forty-one patients also underwent antegrade TEVAR placement after arch reconstruction. Multivariable logistic regression was performed to identify predictors of operative mortality.
Results: 121 patients were identified. Fifty-four (44.63%) were reoperations. Comorbidities are listed in Table 1. 35 (28.9%) were performed for acute Type A dissection. The average CPB time was 250.7 + 59.3 minutes and the average DHCA time was 19.05 + 10 mins. The average ACP time was 32.6 + 16.9 mins. Overall operative mortality was 5.8% (n=7). Permanent neurological event rate was 9.2%. Re-exploration rate for bleeding was 3.3%. Fifteen patients (12.4%) underwent subsequent aortic intervention with a single CVA and one mortality (6.7%). Multivariable analysis demonstrated renal failure as a predictor of mortality (Table 2). Conclusions: This contemporary series of Zone 2 aortic arch reconstructions has shown that brief periods of DHCA followed by ACP are safe and well tolerated in both acute and chronic conditions.
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