Moderate Temperature In Stanford Type A Aortic Dissection Surgery Application Experience

Objective:To discuss the safety of moderate hypothermia cardiac arrest in typeA aortic dissection surgery treatment.Methods:Retrospective study of clinical material of100type A aorticdissection patients who received aortic arch repair at2nd hospital of JilinUniversity from January2012to March2014.50patients had cardiacarrest at25℃between Janurary2012and April2013while50patientshad cardiac arrest at28℃between May2013and March2014.All thepatients had cardio-pulmonary bypass intubation of femoral artery.superior vena cara and inferior vena cara while at present the mostcommomly used CPB intubation method is right axillary and bothfemoral arteries. We used in nominate artery and right carotid arteryintubation for brain perfusion.All the patients had surgical method ofreplacement of ascending aorta. modified arch replacement andimplantation of stent-graft in descending aorta.Result:Comparision of pre-operative and post-operative material was donebetween the two groups. The cooling time of28℃group was21.04±4.5(min).caridac arrest time was36.04±5.6(min).rewarming timewas8.4±18.7(min).CPB time was136.6±18.2(min).operative timewas318.6±48.6(min).post-operative conscious recovery time was12.3± 18.6(h)and24h drainage of was176.6±130.9(ml).The data wassignificantly lower than25℃group.The data of25℃group wasrespectively32.8±9.5(min).38.2±8.3(min).78.4±18.7(min).168.6±28.7(min).366.6±54.7(min).17.6±48.7(h).168.6±122.7(ml). As forthe liver and renal function between the2groups, there was nosignificant difference between the2groups. The AST.ALT.Cre and Tbilof28℃group was71.65±146.8，106.5±231.6，154.56±64.5，59.2±44.1while the25℃group was74.14±128.48，189.6±325.8，137.1±52.2，54.5±36.6.3patients in28℃group received CRRT and4patients received CRRT in28℃group. A total of5patients diedpostoperatively,2patients in28℃group died of multiorgandysfunction.3patients of25℃group died,in which one of sepsis shockand2of MODS.Conclusion:Comparing cardiac arrest at28℃and25℃,with sufficient brain andspinal cord perfusion,the28group wouldn’t incrase brain and spinal cordischemia risk and wouldn’t incrase liver.renal and lung dysfunction riskeither.So cardiac arrest at anal temperature of28℃in type A aorticdissection shortened cooling and rewarming time, further shorteningoperative time and incrasing operative safety. So we can arrive at aconclusion that cardiac arrest at28in treating type A aortic dissection issafe and reliable.