Comparison Of Clinical Results After Selective Cerebral Perfusion Alone And Combined With Distal Perfusion In Aortic Hemiarch Replacement
JUAN S. JARAMILLO, JUAN C. RODRIGUEZ, NATHALIA GONZÁLEZ, DANERY OTALVARO, JUAN C. RENDON.
CLINICA CARDIOVID, Medellin, Colombia.
OBJECTIVE: Due to the fact that the tolerance of cerebral ischemia is restricted under normothermia to very few minutes and, even under hypothermia it can only be prolonged with limitation, the use of selective cerebral perfusion(SCP) to protect the brain during cardiac surgery, became a standard of care for complex procedures like aortic hemiarch replacement(AHR). Although the tolerance of other organs to ischemia is longer than the brain, new perfusion strategies like distal perfusion(DP) in addition to SCP, are being developed in order to improve organ protection below the neck. This study aimed to compare clinical and surrogate outcomes between patients under SCP alone and DP with SCP during AHR in a cardiovascular referral center in Colombia.
METHODS: Cross sectional study of all consecutive patients who underwent AHR between January of 2013 and December of 2016. Quantitative variables were expressed as mean ± standard deviation. Comparison between qualitative and quantitative variables were performed using chi squared test and t test. The statistical analysis was performed with the SPSS v20.0 (SPSS Inc., Chicago, IL, USA). Mortality, length of stay, and length of intubation were examined as dependent variables.
RESULTS: 31 patients were included and divided in two main groups according to the perfusion technique. 17 patients were treated with SCP alone, while 14 were treated with DP plus SCP. Groups were comparable as it is shown in table 1 section-A. With respect to the clinical outcomes (table 1 section-B), in the statistical analysis, no association between the type of perfusion and length of stay, length of ICU stay, hours of intubation, intraoperative mortality, postoperative mortality or organ dysfunction could be demonstrated. Nonetheless, there is a trend toward less mortality and organ dysfunction that favors combined SCP and distal perfusion.
CONCLUSIONS: Although the present study lacks of statistical power, combined SCP and DP is a novel technique that may improve clinical results in patients who underwent complex cardiac surgeries. More studies are needed to support our findings.
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