Efficacy and Safety of Intermittent Pressure-augmented Retrograde Cerebral Perfusion for Acute Aortic Dissection Type A in Nonagenarians

Mitsuhiro Kawata, Tomohiro Murata, Akiko Mano, Takashi Nishimura, Shunei Kyo

The Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan

Date, time and location: 2018.05.27 08:30, Congress Hall, 2F–B

Abstract

Objective: Surgical treatment in the elderly patient with acute aortic dissection type A (AAD-A) is associated with higher mortality and morbidity, it therefore remains controversial in nonagenarians. In our hospital, we have a mission to treat them.

Clinical effectiveness of intermittent pressure-augmented retrograde cerebral perfusion (IPA-RCP) for brain protection in AAD-A surgical treatment has been reported in previous annual meeting of ASCVTS. We assessed efficacy and safety of IPA-RCP for AAD-A in nonagenarians.

Methods: Between April 2015 and October 2017, we performed 22 cases (13 women, mean age: 69.8 year-old) of the ascending aortic repair using IPA-RCP for AAD-A. Of which 4 were nonagenarians (mean age: 91.5 year-old). Open distal anastomosis was performed with IPA-RCP in all cases. IPA-RCP protocol: The oxygenated blood was perfused through SVC cannula at base line pressure of 15mmHg to 20mmHg. The pressure augmented at 45 mm Hg was attempted and was then lowered. The duration of the augmentation was 30 seconds.

Results: Mean Japan Score was 22.4%, plus major complication was 58.7%. IPA-RCP time was 44±14min. The clinical end point was defined as time to regain consciousness, 8.9±6.5 hours; mechanical ventilation time, 16±7.6 hours; and no neurological complications. All patients were extubated successfully. There were two hospital deaths due to gastrointestinal ischemia on the day 1 and acute cholecystitis on the day 23. Rest of the nonagenarians discharged home on foot. Mean hospital stay duration was 20±4 days. They are still alive postoperatively 6 months, or 21 months.

Conclusions: IPA-RCP was effective and safe for brain protection of AAD-A surgical treatment in select nonagenarians.