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J Thorac Cardiovasc Surg 2009;138:1087-1089
© 2009 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr Joseph Bavaria (Philadelphia, Pa). I want to thank the Association as well as Dr Chen for this work. This contemporary series from Dr Chen at Emory contributes to the now near-overwhelming knowledge base that circulation management during open aortic arch procedures using adjunctive cerebral protection concepts, which in this case is antegrade cerebral perfusion, is superior to deep hypothermic circulatory arrest alone. I have a few questions after reading the manuscript for Dr Chen.

The first is, your elective SACP results are outstanding, with a mortality rate of 4.3% and a permanent cardiovascular accident risk of 2.9%. This is in the paper. On the other hand, your elective deep hypothermic circulatory arrest alone results were quite poor, at 23.1% mortality, which was actually higher than the emergency group. Why do you think there was such a disparity?

Dr Chen (Atlanta, Ga). Thank you, Dr Bavaria. We were disappointed and somewhat puzzled by those results. I can tell you that we were very conservative in categorizing elective versus emergency. Because the numbers were low, we were able to look at the 6 deaths in the elective group. Two of those patients were having elective procedures but had an intraoperative unexpected aortic emergency, which was not able to be repaired primarily, necessitating an aortic replacement. Those were 2 patients that we chose to leave in the elective group. Other patients were all very high risk. One patient was 6 weeks postoperative from a type A dissection with renal failure, was heparin-induced thrombocytopenia positive, and had an infected graft with ongoing low-grade sepsis that needed an operative procedure, and then 2 others were multiple operations in patients who had had reoperative surgery in the setting of either aortic . . . [Full Text of this Article]