New Frontiers in Aortic Therapy: Focus on Deep Hypothermic Circulatory Arrest

作者：Gutsche Jacob T; Ghadimi Kamrouz; Patel Prakash A; Robinson Albert R III; Lane Bernard J; Szeto Wilson Y; Augoustides John G T^*

来源：Journal of Cardiothoracic and Vascular Anesthesia, 2014, 28(4): 1159-1163.

DOI：10.1053/j.jvca.2014.03.018

• deep hypothermic circulatory arrest
• adult aortic arch repair
• moderate hypothermia
• mild hypothermia
• antegrade cerebral perfusion
• retrograde cerebral perfusion
• cardiopulmonary bypass
• hybrid aortic arch repair
• international aortic arch surgery study group
• meta-analysis
• expert consensus
• randomized controlled trial
• clinical registry
• stroke
• temporary neurologic dysfunction

There is currently a paradigm shift in the conduct of adult aortic arch repair. Although deep hypothermic circulatory arrest has been the classic perfusion platform for adult aortic arch repair, recent developments have challenged this aortic arch paradigm. There has been a gradual clinical drift towards moderate, and even mild, hypothermic circulatory arrest combined with antegrade cerebral perfusion. This paradigm shift appears to be associated with equivalent clinical outcomes, and in certain settings, with improved outcomes. The advent of endovascular therapy has challenged even further the concept that circulatory arrest is required for adult aortic arch repair. These dramatic advances have resulted in the emergence of an international aortic arch surgery study group that aims to advance this dynamic field through consensus statements, meta-analysis, clinical database analysis, prospective registries, and randomized controlled trials.

• 出版日期2014-8