Intermittent upper and lower body perfusion during circulatory arrest is safe for aortic repair

Abstract

Introduction: We report our initial surgical experience of intermittent upper and lower body retrograde perfusion during aortic repair under circulatory arrest. Methods: Between 2007 and 2015, 148 consecutive patients underwent surgical aortic repair using moderate hypothermic circulatory arrest with intermittent upper and lower body retrograde perfusion. Results: All patients underwent ascending aorta replacement; eight had hemiarch replacement (5.4%) and 92 had aortic root surgery (62.2%). Twenty-nine patients (19.6%) had re-operations and 60 patients (40.5%) had concomitant procedures. The mean duration of circulatory arrest was 23.2 ± 5.4 minutes (range 13-48 minutes). Hospital length of stay was 11.3 ± 16.9 days (median 7.0 days; interquartile range [IQR] 6 days). Complications included death in 0.7%, stroke in 3.4%, respiratory failure in 12.8%, renal replacement therapy in 2.0% and re-exploration for bleeding in 0.7%. Peak renal and hepatic biomarkers were: creatinine 1.2 ± 0.3 mg/dL, aspartate aminotransferase (AST) 291 ± 1112 U/L (IQR 91.8 U/L), alanine aminotransferase (ALT) 212 ± 924 U/L (IQR 43.0 U/L) and total bilirubin 1.2 ± 0.9 mg/dL. Peak lactate was 5.0 ± 3.3 mmol/L (IQR 3.3 mmol/L) and the mean time to normalization (<2 mmol/L) was 14.3 ± 14.0 hours. Conclusions: Intermittent upper and lower body retrograde perfusion during circulatory arrest is safe for aortic repair, resulting in low morbidity and mortality. There were only modest rises in hepatic and renal injury biomarkers as well as the rapid clearance of lactate. These findings support the continued study of this technique to reduce end-organ dysfunction during circulatory arrest, including expansion to patients with longer circulatory arrest duration and a direct comparison with conventional circulatory arrest without retrograde upper and lower body perfusion.