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Minimized perfusion circuit for acute type A aortic dissection surgery
Author(s) -
Kimura Naoyuki,
Momose Naoki,
Kusadokoro Sho,
Yasuda Toru,
Kusaura Rie,
Kokubo Ryo,
Hori Daijiro,
Okamura Homare,
Itoh Satoshi,
Yuri Koichi,
Yamaguchi Atsushi
Publication year - 2020
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/aor.13724
Subject(s) - medicine , extracorporeal circulation , surgery , perfusion , aortic dissection , cerebral perfusion pressure , anesthesia , coagulopathy , cardiopulmonary bypass , cardiology , aorta
Abstract A minimized perfusion circuit (MPC) may reduce transfusion requirement and inflammatory response. Its use, however, has not been standardized for complicated cardiovascular surgery. We assessed outcomes of surgery for acute type A aortic dissection (ATAAD) performed with a MPC under circulatory arrest. The study involved 706 patients treated surgically for ATAAD (by hemiarch repair [n = 571] or total arch repair [n = 135]). Total arch repair was performed using selective antegrade cerebral perfusion. Our MPC, a semi‐closed bypass system, incorporating a completely closed circuit and a level‐sensing reservoir in the venous circuit, was used. Clinical variables, transfusion volume, and outcomes were investigated in patients who underwent hemiarch repair or total arch repair. The overall incidences of shock, organ ischemia, and coagulopathy (prothrombin time–international normalized ratio >1.5) were 26%, 35%, and 8%, respectively. Mean extracorporeal circulation (ECC) time was 149 minutes for the hemiarch repair group and 241 minutes for the total arch repair group, respectively. No patient required conversion to conventional ECC, and there were no complications related to the use of the MPC. The need for transfusion (98% vs. 91%, P = .017) and median transfusion volume (1970 vs. 1680 mL, P = .002) was increased in the total arch repair group. Neither in‐hospital mortality (total arch; 12% vs. hemiarch; 7%, P = .11) nor 10‐year survival (74.4% vs. 68.4%, P = .79) differed significantly. Outcomes of surgery for ATAAD performed with the MPC were acceptable. The possibility of transfusion and transfusion volume remains high during such surgery, despite the use of the MPC.