P374. Validity of Ascending Aortic Replacement under Moderate Hypothermic Circulatory Arrest with Retrograde Cerebral Perfusion

Objective:
Brain protection during ascending aortic replacement (AAR) for thoracic aortic aneurysms (TAA) and cooling temperatures is a critical issue. The usefulness of retrograde cerebral perfusion (RCP) has already been reported, but safety reports on moderately cooled RCP are lacking. We therefore compared early and mid-term results of AAR with aortic clamping and open-distal AAR with moderately cooled RCP.

Methods:
A single-center retrospective analysis was performed for all patients who underwent AAR, and not dissection, for only TAA. A total of 310 patients who underwent either clamped AAR (n=88, Group C) or non-clamped open-distal AAR (n=222, Group O) between April 2011 and May 2023 were included. Concomitant procedures were also included.
Primary endpoints were perioperative stroke and five-year survival, whereas secondary endpoints included 30-day mortality and remote arch re-intervention.

Results:
The mean age of all patients was 65±13 years. The lowest rectal temperature was 23.4±9℃, and circulatory arrest time was 17 minutes in Group O. One case of perioperative stroke was recorded in Group C, while there was none in Group O (P=0.284). Thirty-day mortality was observed in three and two patients (2% vs 1%, P=0.141) for Group C and Group O, respectively. Five-year survival was 90.8±3.3% and 88.7±3.4% (P=0.950) and avoidance rate of arch re-intervention was 94.6±3.1% and 97.5±2.5% (P=0.414) for Group C and Group O respectively.


Conclusion:
Ascending aortic replacement under moderate hypothermic circulatory arrest using retrograde cerebral perfusion in patients with ascending aortic aneurysms did not cause any permanent neurological dysfunction. Therefore, ascending aortic replacement may be safe and feasible under moderate hypothermic circulatory arrest with retrograde cerebral perfusion.

daiki saitoh (1), Naoya Sakoda (2), yuya yamazaki (3), Tatsunori Tsuji (4), Azuma Tabayashi (5), Kazuki Yakuwa (6), Junichi Koizumi (5), Hajime Kin (7), (1) N/A, N/A, (2) Okayama University Hospital, N/A, (3) Iwate Medical University, Iwate, iwate, (4) Iwate Medical University, yahaba, Iwate, (5) Iwate Medical University, Iwate, Iwate, (6) Iwate Medical University, iwate, iwate, (7) Iwate Medical University, Iwate, NA

Daiki Saito

Poster Presenter

Education

2019 - present: Ph.D. Candidate,

Graduate school of Medical Science, Iwate Medical University, Japan

“The postoperative patterns of the collateral arteries to the spinal cord after the thoracoabdominal aortic aneurysm repair   ~Open surgical repair versus endovascular stent grafting~” Advisor: Professor. Hajime Kin

2007-2013: M.D., Niigata University School of Medicine

 

Work Experience

2019 April - present: Staff Cardiothoracic Surgeon, Department of Cardiovascular surgery, Iwate Medical University, Japan

2015 - 2019: Senior Resident, Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan

2013 - 2015: Junior Resident, Aso Iizuka hospital, Fukuoka, Japan

 

Peer-reviewed Publication

1 Saitoh D, Sakoda N, Tabayashi A, et al.  Aortic Floating White Thrombus in an Ascending Aortic Graft After Aortoplasty: Ann Thorac Surg Short Reports (2023) 1:610-612

 

2 Saitoh D, Saji M, Takanashi S. Extended myectomy for apical hypertrophic cardiomyopathy: a case report. Journal of Cardiothoracic Surgery (2021) 16:360

 

3 Saitoh D, Yoshioka K, Kin H. Collateral pathways to the artery of Adamkiewicz. Asian Cardiovascular & Thoracic Annals (2021) 29(9):968-969

 

4 Saitoh D , Kin H. A stuck mechanical valve curtained by thrombosis. European Journal of Cardio-Thoracic Surgery (2021)59: 921

 

5 Saitoh D , Kin H. Aortic valve replacement after iatrogenic injury related to an Impella device. Asian Cardiovascular and Thoracic Annals (2020) 29:5  

 

6 Saitoh D, Tsuji S, Takinami G, et al. Metastasis of Clear Cell Renal Cell Carcinoma to the Left Ventricle. Kyobu geka. The Japanese Journal of Thoracic Surgery (2020) 73(11):910-913

 

7  Saitoh D, Shimizu A, Takanashi S. Open Heart Surgery Using an Endotracheal Tube Introducer in a Patient with Tracheobronchopathia Osteochondroplastica; Report of a Case. Kyobu geka. The Japanese Journal of Thoracic Surgery(2019) 72(13):1097-1099