Management of cardiopulmonary bypass in elderly patients with acute type A aortic dissection of aortic arch reconstruction

Abstract

Objective To summarize the clinical experience of cardiopulmonary bypass(CPB) in acute type A aortic dissection received aortic arch reconstruction on age over 70 years patients. Methods From April 2013 to December 2017, 35 elderly patients aged over 70 who were involved the aortic arch, brachiocephalic trunk, left common carotid artery and left subclavian artery and severe arch lesions, large false lumen and large rupture risk of acute A aortic dissection were reconstructed by triple-branched stent graft in emergency extracorporeal circulation. During the period of cardiopulmonary bypass, selective cerebral perfusion and discontinuous arrest under moderate hypothermia(25 degrees C) were used to reduce the time of cerebral ischemia and hypoxia, and to strengthen the management of the protection of important organs. Results Cardiopulmonary bypass time was(144.85±32.98)minutes, and aortic cross clap time was(51.82±17.59)minutes, and selective cerebral perfusion time was(12.17±4.70)minutes, discontinuous arrest time was(4.50±3.54) minutes, the lower body arrest time was(16.6±7.49)minutes. All patients were smoothly weaned from cardiopulmonary bypass.35 patients resuscitated within 48 hours, of which 3 patients had transient mental disorders in the early stage and recovered before hospital discharge; 2 patients had cerebral infarction. Hospital mortality in this group was 17.1%(6/35). Conclusion Advanced age is not a contraindication to the reconstruction of the arch of the aortic dissection. Reasonable management of cardiopulmonary bypass can provide an important guarantee for the reconstruction of the elderly patients with acute type A aortic dissection. Key words: Elderly patients Acute type A aortic dissection Cardiopulmonary bypass