Vallabhajosyula and colleagues from the University of Pennsylvania compared retrospectively 301 deep hypothermic circulatory arrest with retrograde cerebral perfusion (DHCA+RCP) with 75 undergoing moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA+ACP) who had elective reconstructions of the hemi-arch. Deep hypothermia was considered ≤ 20C while moderate was 25-28C. ACP was conducted with unilateral perfusion of either the axillary or innominate artery.
Use of MHCA+ACP significantly reduced the duration of cardiopulmonary bypass and cross-clamp. Average arrest time was 18 mins vs 23 mins in the MHCA and DHCA cohort (p<0.001). Mortality, stroke, and transient ischemic attacks were similar between the cohorts, although there was a reduction in the use of blood products in the MHCA+ACP cohort.
The authors concluded that MHCA with antegrade cerebral perfusion yields excellent and equivalent outcomes to DHCA for elective aortic hemiarch reconstruction.
The full manuscript is available online here.
Vallabhajosyula P, Jassar AS, Menon RS, Komlo C, Gutsche J, Desai ND, Hargrove WC, Bavaria JE, Szeto WY. Moderate Versus Deep Hypothermic Circulatory Arrest for Elective Aortic Transverse Hemiarch Reconstruction. Ann Thorac Surg. 2015 Mar 27. pii: S0003-4975(15)00062-4. doi: 10.1016/j.athoracsur.2014.12.067. [Epub ahead of print]