Do not leave the heart arrested. Non-cardioplegic continuous myocardial perfusion during complex aortic arch repair improves cardiac outcome

Abstract

Routinely protecting the heart during complex aortic arch repair with non-cardioplegic CMP is a valuable new concept. The CMP technique is feasible and safe, does not prolong aortic arch repair, reduces myocardial damage and improves cardiac outcome. Further evaluation in a larger patient cohort is warranted to establish this novel technique.

Total aortic arch replacement with a novel 4-branched frozen elephant trunk prosthesis: Single-center results of the first 100 patients

“…Of these patients, 3 presented with AAD and 2 with malperfusion. In both patients who died due to cardiac failure, beating heart aortic arch surgery technique 12 was not used.…”

“…To minimize cardiac ischemia time, we initiated the beating heart aortic arch surgery technique as routine procedure. 12 During cooling aortic root and concomitant cardiac procedures were completed.…”

“…The aortic arch was then replaced on an empty beating heart. 12 3. Spinal cord protection HCA temperature was kept below 26 C and perioperative cerebrospinal fluid (CSF) drainage was performed (12 mm Hg).…”

Editor's Choice – Current Options and Recommendations for the Treatment of Thoracic Aortic Pathologies Involving the Aortic Arch: An Expert Consensus Document of the European Association for Cardio-Thoracic Surgery (EACTS) & the European Society for Vascular Surgery (ESVS)

“…In addition, selective myocardial perfusion during arch repair ('heart beating' concept) is used to reduce cardioplegic arrest times and to allow more extensive proximal surgical procedures. 170 To secure the FET treatment, the use of a guidewire, preferably via the FA under angiographic or echocardiographic control, may be of help. In aortic dissections, the wire secures FET deployment within the true lumen.…”

Extracorporeal cardiopulmonary resuscitation for out-of-hospital refractory cardiac arrest: A word of caution

“…Surgical technique included the use of a branched hybrid graft (Vascutek Thoraflex; Vascutek Ltd a Terumo Company, Inchinnan, UK) and noncardioplegic continuous myocardial blood perfusion during aortic arch repair (beating heart aortic arch surgery). 7 Although patient characteristics were similar to the group treated between 2001 and 2013, operative mortality was 0% and the stroke rate was 0%. Reoperation for bleeding occurred in 6% (n ¼ 1).…”