Send to:

Choose Destination
See comment in PubMed Commons below
J Thorac Cardiovasc Surg. 2013 Jul;146(1):119-23. doi: 10.1016/j.jtcvs.2012.06.047. Epub 2012 Jul 20.

Early and midterm outcomes of quick proximal arch replacement with mild hypothermia and rapid rewarming for type A acute aortic dissection.

Author information

  • 1Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan.



We assessed the efficacy of our unique procedure with mild hypothermic circulatory arrest and rapid rewarming during emergency surgery for type A acute aortic dissection.


During the last 6 years, 91 patients with acute aortic dissection and an average age of 66.2 ± 14.1 years underwent our newly modified quick hemiarch replacement. Eighteen patients (19.8%) had independent predictors for surgical mortality, such as preoperative cardiopulmonary arrest or malperfusion of vital organs. During open distal anastomosis with a rectal temperature of 28°C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40°C, accompanied by warming of the patient's body using a heating mat. As soon as distal anastomosis was completed, rapid rewarming was initiated by 40°C blood perfusion.


Circulatory arrest, cardiopulmonary bypass, and overall operation times were 19.1 ± 5.1, 86.2 ± 17.8, and 150.1 ± 25.2 minutes, respectively. Five patients (5.5%) required reexploration for bleeding, and 4 patients (4.4%) had strokes, but none had acute renal failure. The hospital mortality rate was 3.3% (3 patients), and the postoperative hospital stay was 10.6 ± 4.7 days. Five patients required replacement of the distal arch or descending aorta at a later stage. Eight patients died during follow-up. A postoperative midterm computed tomography scan revealed a closed distal arch in more than 80% of patients and partial abdominal open false lumen in 45% of patients. Echocardiograms showed mild aortic valve regurgitation in 8 patients. The freedom from reoperation rate at 5 years was 90.0%. Actuarial survival including operative death was 82.7% at 5 years.


Our original technique is a safe and less-invasive procedure that enables a quicker surgery. The midterm outcome also was favorable.

Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

[PubMed - indexed for MEDLINE]
PubMed Commons home

PubMed Commons

How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science
    Loading ...
    Write to the Help Desk