Adaptive Perfusion in Aortic Arch Surgery

Tatiana B. Averina, Alexander S. Shundrov, Vladimir A. Mironenko , Sergey V. Rychin , Nidal A. Darvish

Bakulev National Medical Research Center of Cardiovascular Surgery, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Press Hall, 2F

Abstract

To minimize intraoperative ischemia during the complicated aortic arch surgery, we introduced the technique of adaptive perfusion (AP), which is a flexible combination of CPB (cardiopulmonary bypass) methods, aimed at protecting the brain and spinal cord, internal organs, and limbs.

Methods. This open non-randomized study enrolled 58 patients in the settings ofAP study group (n=22) or uni-/bilateral cerebral perfusion and circulatory arrestcontrol group(n=36). We analysed a number of clinical, haematological and biochemical parameters at T0 (before CPB), T1 (after CBP), T2 (at ICU admission), and T3-T5 (on the 3rd, 4th, and 5th postoperative days).

Results. The patients did not differ by age 50.0 [41.0; 56.5] vs 53.0 [43.5; 61.8], gender (males 59.0% vs 63.9%). The patients of the study group required a more complex surgery: aortic arch reconstruction was performed in 77% patients (vs 44.5%) and brachiocephalic artery reconstruction in 50% patients (vs 8.3%). Two groups did not differ by CPB (276.5 [251.3; 306.2] vs 264.0 [206.0; 302.0] min) and cross-clamping time (170.0[127.75; 206.25] vs 152.00 [117.00; 179.25] min). Circulatory arrest was shorter in the study group (35.0 [21.8; 47.5] vs 44.0 [35.0; 66.8] min;р=0.02). The AP providedlower lactate levels from T1 until T5 (p<0.05); better preservation of platelets atТ1 (123.5 [98.5; 167.5] x 10⁹/ lvs 90.0 [61.8; 127.8] x 10⁹/l; p=0.03), lower blood loss at T3(250.0 [200.0; 425.0] vs 400.0 [360.1; 540.0] ml;р=0.02) and reduction of the visceral organ lesions, as evidenced by the changes in biochemical markers: amylaseТ4(99.0 [43.25; 255.3] vs 664 [290.0; 984.5]U/l;р=0.007); amylaseТ5 (71.5 [30.0; 172.5] vs 346 [196.0; 578.5]U/l; p=0.01); ASTТ5 (86.5 [58.0; 147.3] vs 142.0 [95.0; 262.7]U/l;р=0.03).

Conclusions. The AP provides more adequate aerobic metabolism maintenance, visceral organ protection, and preservation of blood coagulation potential.