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ORIGINAL ARTICLE

Surgical treatment of type A aortic dissections utilizing total cardiocirculatory arrest with deep hypothermia

Luciano Cabral AlbuquerqueI; Marco Antônio GoldaniI; Juremir João GoldaniI; Ricardo Medeiros PiantáI; Rubens Lorentz AraújoI; João Batista PetraccoI

DOI: 10.1590/S0102-76381993000100001

ABSTRACT

From July 1986 to July 1993, 22 consecutive patients with Type A Aortic Dissecation were surgically treated using total cardiovascular arrest with deep hypothermia (18ºC). Fifteen cases had acute dissecations and 7 were chronic cases. In 14 cases (64%), the ascending aorta was reconstructed using a straight Dacron graft. In 5 of these, the aortic valve was repaired. The aortic arch was reconstructed in 8 cases (36%) and in 3 of these, the arch branches were reimplanted. The average time of the cardiovascular arrest was 43 minutes and the hospital mortality was 18%. The most frequent complication was respiratory infection, 5 patients (22.7%) showed neurologic damage, 4 of them transient and reversible. In summary, the cardiovascular arrest with deep hypothermia technique for the treatment of Type A Aortic Dissection can be used with reasonable mortality and morbility allowing a safe cerebral protection, good exposure of the dissected aorta and prevents damage to the aortic wall by the cross clamping.

RESUMO

No período de julho de 1986 a julho de 1993, 22 pacientes portadores de dissecção de aorta tipo A foram tratados cirurgicamente utilizando-se parada cardiocirculatória (PCC) total sob hipotermia profunda (18ºC), dos quais 15 apresentavam dissecção aguda e 7 dissecção crônica. Em 14 casos (64%) a aorta ascendente foi reconstruída utilizando-se enxerto reto de Dacron, com troca valvar aórtica em 5 pacientes e ressuspensão valvar aórtica em 2; a reconstrução do arco aórtico foi empregada em 8 casos (36%), nos quais a dissecção se extendia ou se originava no mesmo, havendo necessidade de reimplante dos ramos supra-aórticos em 3 pacientes. O tempo médio do PCC foi de 43 minutos, a mortalidade hospitalar foi de 18%, e a complicação pós-operatória mais freqüente foi a infecção respiratória. Cinco pacientes (22,7%) apresentaram dano neurológico pós-operatório, sendo, em 4 casos, reversível e atribuível a edema cerebral; 1 caso (4,5%) apresentou acidente vascular hemisférico estabelecido. Concluímos que a técnica de PCC sob hipotermia profunda deve ser utilizada sempre no reparo das dissecções de aorta tipo A, independentemente de sua extensão ao arco aórtico, pois oferece uma proteção cerebral segura, permite a inspeção ampla da zona dissecada e do local de rotura da íntima, e evita o trauma produzido pelo clampeamento da aorta acometida.
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Article receive on Thursday, March 18, 1993

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