RESUMEN
Abstract Introduction: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Methods: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. Results: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%. Conclusion: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.
Asunto(s)
Humanos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Aneurisma de la Aorta/cirugía , Encéfalo/irrigación sanguínea , Puente Cardiopulmonar/métodos , Reperfusión/métodos , Paro Circulatorio Inducido por Hipotermia Profunda/métodos , Disección Aórtica/cirugía , Aneurisma de la Aorta/mortalidad , Complicaciones Posoperatorias , Factores de Tiempo , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/mortalidad , Reperfusión/efectos adversos , Reperfusión/mortalidad , Modelos Logísticos , Enfermedad Aguda , Reproducibilidad de los Resultados , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Paro Circulatorio Inducido por Hipotermia Profunda/efectos adversos , Paro Circulatorio Inducido por Hipotermia Profunda/mortalidad , Hemodinámica , Disección Aórtica/mortalidad , Enfermedades del Sistema Nervioso/etiologíaRESUMEN
Las ondas J o de Osborn son deflexiones positivas al final del complejo QRS, que han sido descritas en electrocardiogramas de pacientes con hipotermia. Se presenta el caso de un paciente masculino de 62 años de edad con hipotermia, cuyo electrocardiograma mostró bradicardia sinusal y ondas de OSBORN...