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Gianpaolo Romano
Cristiano Amarelli
Michele Torella
Attilio Renzulli
Maurizio Cotrufo
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J Thorac Cardiovasc Surg 2003;126:826-831
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Surgical repair of acute type a aortic dissection: continuous pulmonary perfusion during retrograde cerebral perfusion prevents lung injury in a pilot study

Luca Salvatore De Santo, MDa,*, Gianpaolo Romano, MDa, Cristiano Amarelli, MDa, Francesco Onorati, MDa, Michele Torella, MDa, Attilio Renzulli, MD, FECTSa, Nicola Galdieri, MDb, Maurizio Cotrufo, MD, FECTSa

a Department of Cardio-Thoracic and Respiratory Sciences, V. Monaldi Hospital, Second University of Naples, Naples, Italy
b Cardiac Surgery Intensive Care Unit, V. Monaldi Hospital, Second University of Naples, Naples, Italy

Presented at the Sixteenth Annual Meeting of The European Association for Cardio-Thoracic Surgery, Monte Carlo, Sept 22-25, 2002.

Received for publication October 11, 2002; revisions received November 6, 2002; revisions received December 27, 2002; accepted for publication January 22, 2003.

* Address for reprints: Luca Salvatore De Santo, MD, Viale Colli Aminei 491, 80129, Naples, Italy
luca.desanto{at}ospedalemonaldi.it

OBJECTIVE: Postoperative respiratory failure is a frequent and serious complication in patients with type A acute aortic dissection operated on with deep systemic hypothermia. Interaction between neutrophils and pulmonary endothelium along with ischemic insult and reperfusion are the major determinants of lung injury. The aim of this prospective study was to evaluate the effect of continuous pulmonary perfusion during retrograde cerebral perfusion on lung function.

METHODS: Twenty-two patients referred for acute type A aortic dissection, who were free from preoperative respiratory dysfunction, were assigned prospectively and alternately to one of 2 treatment groups. Pulmonary perfusion was performed during retrograde cerebral perfusion in group B (11 patients), whereas the conventional Ueda technique was applied in group A (11 patients). Lung function was evaluated on the basis of intubation time, scoring of chest radiographs at 12 hours after cardiopulmonary bypass, and PaO2/fraction of inspired oxygen ratio assessed from immediately before the operation to 72 hours after termination of cardiopulmonary bypass.

RESULTS: Study groups were homogeneous for age, sex, interval between symptom onset and surgical operation, previous aortic surgery, preoperative ejection fraction and pulmonary gas exchange function, extent of aortic repair, and concomitant procedures. Cardiopulmonary bypass time, length of retrograde cerebral perfusion, operation time, need for blood substitutes, and surgical revision for bleeding did not differ between treatment groups. Postoperative PaO2/fraction of inspired oxygen ratios were higher in group B than in group A, and the difference remained statistically significant throughout the study period. The incidence of prolonged ventilator support (>72 hours) and the severity of the radiographic pulmonary infiltrate score were lower in the perfused group (18.2% vs 72.7% [P = .015] and 0.81 ± 0.75 vs 1.8 ± 0.78 [P = .028], respectively).

CONCLUSIONS: Continuous pulmonary perfusion provided a better preservation of lung function in patients operated on with deep systemic hypothermia.




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