Safety of retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement.

OBJECTIVES: Aortic surgeries performed under moderate hypothermia require antegrade cerebral perfusion. The influence of retrograde cerebral perfusion under moderate hypothermic circulatory arrest remains unknown. To clarify this effect, this study aimed to compare the early outcomes of retrograde versus antegrade cerebral perfusion under moderate hypothermia for hemiarch replacement. METHODS: Between March 2009 and April 2020, 391 hemiarch replacements under moderate hypothermic circulatory arrest via median sternotomy were performed at our institution. Of these, 70 involved retrograde perfusion and 162 involved antegrade perfusion. Propensity score matching was used to compare 61 pairs of retrograde and antegrade cases. RESULTS: Retrograde and antegrade strategy under moderate hypothermia resulted in comparable operative mortality (3.3% vs. 1.6%, P > 0.99), permanent neurological deficits (8.5% vs. 6.6%, P > 0.99), and temporary neurological deficits (24.6% vs. 39.3%, P = 0.33). Retrograde surgery was associated with shorter circulatory arrest times (31.4 ± 8.2 min vs. 37.4 ± 12.2 min, P = 0.005) and fewer red blood cell transfusions (4.6 ± 3.9 units vs. 8.2 ± 5.1 units, P < 0.001) than those with antegrade surgery. CONCLUSIONS: Retrograde cerebral perfusion under moderate hypothermia for hemiarch replacement yields excellent operative outcomes, equivalent to those achieved using an antegrade strategy.

Atypical presentation of isolated traumatic ascending aortic dissection with cardiac tamponade.

Blunt traumatic aortic injury is a rare but life-threatening condition, usually following high-energy trauma. We present the case of a 79-year-old man who was transferred to a hospital complaining of nausea after being struck on the chest. Computed tomography led to diagnosis of ascending aortic dissection with cardiac tamponade. Emergent ascending aortic replacement was performed successfully and he was discharged home on postoperative day 24 without any complications. The key to early diagnosis of blunt traumatic aortic injury is careful and detailed history-taking. If trauma patients complain of unexplained symptoms, the threshold for conducting computed tomography should be lowered to avoid misdiagnosis or therapeutic delay.

Left ventricular outflow tract obstruction by transatrial left ventricular cannulation.

Transatrial cannulation of the left ventricle was introduced as a safe and easy cannulation method for antegrade arterial return in type A aortic dissection. However, because of the paucity of clinical reports, little is known about the complications or shortcomings of this technique. Herein, we report a case of pulmonary haemorrhage resulting from left ventricular outflow obstruction, necessitating the exchange of the arterial cannulation site. Monitoring the jet of the arterial cannula with transoesophageal echocardiography and pulmonary artery pressure is mandatory for early detection of complications.