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J Thorac Cardiovasc Surg 2008;136:489-493
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Less invasive quick replacement for octogenarians with type A acute aortic dissection

Mitsumasa Hata, MD, PhD*, Mitsunori Suzuki, CE, Akira Sezai, MD, Tetsuya Niino, MD, Satoshi Unosawa, MD, Nobuyuki Furukawa, MD, Kazutomo Minami, MD

Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan

Received for publication November 20, 2007; revisions received December 25, 2007; accepted for publication January 8, 2008.

* Address for reprints: Mitsumasa Hata, MD, Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Ooyaguchi Kamimachi Itabashi-ku, Tokyo 173-8610, Japan. (Email: mihata{at}med.mihon-u.ac.jp).

Objective: We assessed the efficacy of our newly modified technique, namely, less invasive quick replacement with rapid rewarming, for octogenarians undergoing emergency surgery for type A acute aortic dissection.

Methods: Forty-two patients with acute aortic dissection, whose average age was 81.7 ± 2.3 years, were divided into two groups: group I consisted of 25 patients undergoing surgery with deep hypothermic circulatory arrest and selective cerebral perfusion; group II consisted of 17 recent patients who underwent less invasive quick replacement. In the latter technique, during open distal anastomosis with a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40°C accompanied by warming of the patient's body by a heating mat. As soon as the distal anastomosis was completed, rapid rewarming was initiated by 40°C blood perfusion.

Results: The durations of cerebral protection (group I, 75.8 minutes, vs group II, 18.8 minutes), cardiopulmonary bypass (I, 201.2, vs II, 84.4 minutes), and overall operation (I, 425.6, vs II, 148.6 minutes) were significantly shorter in group II. In group I, 5 patients had complications of cerebral damage and 5 required re-exploration for bleeding, 7 had pneumonia, 6 required hemodialysis for renal failure, and the hospital mortality rate was 24% (6 patients). On the other hand, no such complications or mortality were observed in group II (P < .0291). Postoperative hospital stay was significantly shorter for the patients in group II than in group I (13.2 days vs 33.7 days; P < .0001).

Conclusion: Less invasive quick replacement is safe and effective. It should be a standard surgical technique for octogenarians with type A acute aortic dissection.

Abbreviations and Acronyms AAD = acute aortic dissection; ACP = antegrade cerebral perfusion; CPB = cardiopulmonary bypass; DHCA = deep hypothermic circulatory arrest; GRF = gelatin–resorcine–formalin; LIQR = less invasive quick replacement






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