Temperatur- und Perfusionsmanagement bei akuter Typ-A-Aortendissektion

Applied protocols for surgical repair of acute aortic type A dissection are deep hypothermic circulatory arrest (DHCA) alone or hypothermic circulatory arrest with selective retrograde (RCP) or selective antegrade cerebral perfusion (ACP). DHCA was the first successfully used protocol for aortic surgery. However, severe concerns have been raised due to the physiological consequences. In order to reduce the complications of DHCA various levels of systemic hypothermia during circulatory arrest in adjunct with RCP and ACP at different perfusate temperatures have been developed. ACP offers a more physiological method of cerebral perfusion. The level of systemic cooling can be adapted according to the preoperative computed tomography scan and the expected reconstructive time. Moderate to mild systemic hypothermia in combination with ACP can safely and reproducibly applied to various aortic procedures including repair of acute aortic dissection. Selective ACP in combination with mild to moderate hypothermia offers sufficient cerebral and distal organ protection.