Total aortic arch replacement with low temperature cardiopulmonary bypass and selected cerebral perfusion technique / 第二军医大学学报

ABSTRACT

Objective: To summarize our experience on the anesthetic management, cardiopulmonary bypass, and protection of major organs total aortic arch replacement in patients with DeBakey type I aortic dissection. Methods: From June 2005 to June 2006, 5 patients with acute DeBakey type I aortic dissection received total aortic arch replacement under general anesthesia and deep low temperature. The 5 patients, including 3 man and 2 women, with an age range of 49-76 years, all received emergent operation. The clinical data were retrospectively analyzed and the experience on anesthesia management was summarized. Results: All the 5 patients had uneventful anesthesia with propofol. The time of cardiopulmonary bypass was 111-148 min, with a mean of (127.2±16.6) min. The priming solution was Ringer acetate solution. The selective cerebral perfusion time was 11-18 min, with a mean of (15.2±2.8) min. The lowest temperature was 19-22°C, with a mean of (20.4±1.5)°C. Modified pH-stat technique was employed for temperature lowing and the rate of rewarming was controlled strictly. The right axillary artery cannulation was routinely performed for cardiopulmonary bypass and selected cerebral perfusion. The blood transfusion was 600-1 400 ml. The auditory evoked potentials index was 0 during lower body arrest. There were no serious cerebral complications after operations. Four patients survived and one died of renal failure 6 days after operation. Conclusion: General anesthesia combined with deep low temperature and selected cerebral perfusion provides a safe condition for ascending arota and total arotic replacement.