Warm Head - Cool Body in Aortic Arch Surgery – Is It Real?

Evgeny Rosseykin, Michail Evdokimov, Pavel Batrakov, Evgeny Kobzev, Vladlen Bazylev

Federal Center of Cardiovascular surgery, Penza, Russia

Date, time and location: 2018.05.25 13:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objective: Usually hypothermia is the main factor for brain protection during the aortic arch surgery. We offer the technique «warm head - cool body» with normothermic total personal brain perfusion.

Materials and methods.From January 2014 to December 2017 94 patients underwent aortic arch surgery. Indications were aneurysm of the aortic arch (n=45, 47,9%), acute dissection (n=21, 22,3%), chronic dissection (n=28, 29,8%).

“Warm brain – cool body” technique includes:

1. Total personal antegrade normothermic cerebral perfusion – we always used all brachiocefalic arteries with the same volume that we measure before CPB in all arch vessels ("Medistim ASA Veri-Q“, Norway);

2. Two independent circuits (two oxygenators) of perfusion (one for body, one for brain);

3. Branch first technique for arch vessels.

Results. 30-day mortality was 2 patients (2.1%). Cardiopulmonary bypass time were 177,3 min (92-113), antegrade selective cerebral perfusion – 144 min (78-220). One patient had a stroke and one - TIA. Mean ICU and total hospital stay were 3 (2-23) and 11 (7-31) respectively.

Conclusions. “Warm brain – cool body” technique for aortic arch reconstruction is a single physiological method (the personal volume through all arch vessels with normothermia) for natural brain perfusion with good clinical results.