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J Thorac Cardiovasc Surg 2008;136:1536-1540
© 2008 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Does aortic crossclamping during the cooling phase affect the early clinical outcome of acute type A aortic dissection?

Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland

Received for publication February 26, 2008; revisions received April 28, 2008; accepted for publication May 20, 2008.

^_* Address for reprints: Franz F. Immer, MD, Department of Cardiovascular Surgery, University Hospital, 3010 Berne, Switzerland. (Email: franzimmer{at}yahoo.de).

Objectives: The purpose of this study is to evaluate the effects of crossclamping the ascending aorta in acute type A aortic dissection during the cooling phase for deep hypothermic arrest on early clinical outcome.

Methods: The records of 275 consecutive patients who underwent surgery for acute type A aortic dissection were reviewed. Ten patients have been excluded. Overall, 265 patients who underwent surgery under deep hypothermia and circulatory arrest in the "open technique" were divided retrospectively into two groups: those who underwent surgery with crossclamping of the ascending aorta during the cooling phase at the begin of the procedure (group 1, n = 191; 72.1 %) and those in whom the aorta was not clamped (group 2, n = 74; 27.9 %).

Results: Preoperative characteristics were similar in both groups. In group 1, femoral artery cannulation, composite graft repair, and aortic arch replacement were significantly more frequent. In-hospital mortality was 15.2 % in group 1 and 17.6 % in group 2 (P = not significant). Neurologic deficits were observed in 9.4% in group 1 and in 10.8% in group 2 (= not significant). There were no significant differences in clinical outcome between the two groups of patients.

Conclusions: This study demonstrates that both options, aortic crossclamping or noclamping, may be used during the induction of deep hypothermia to repair acute type A aortic dissections with similar early clinical outcome. For the selection of the most appropriate technique, we recommend case by case evaluation, weighing the potential risks and benefits of aortic crossclamping.

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