ArticleInterdisciplinary cardiovascular and thoracic surgery2026
A Comprehensive Total Body Perfusion Strategy vs Conventional Techniques in Elective Aortic Arch Surgery: A Comparative Analysis.
Article in Interdisciplinary cardiovascular and thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectivesAortic arch surgery traditionally relies on hypothermic circulatory and cardioplegic arrest, exposing myocardium and visceral organs to ischaemia-reperfusion injury. We developed a total body perfusion (TBP) strategy providing continuous cerebral, myocardial, and visceral perfusion during arch reconstruction. This study compares outcomes between conventionally and TBP-treated patients.
methodsAnalysis included 121 consecutive elective aortic arch replacements (2014-2025). From June 2022, patients (n = 38) were intended for TBP; earlier cases (n = 83) underwent conventional techniques. TBP comprised continuous warm myocardial, selective cerebral, and retrograde visceral perfusion. Outcomes included intraoperative characteristics, biochemical markers, and clinical outcomes.
resultsBaseline demographics were similar (male 65.8% vs 53.0%, P = .188; median age 63.9 [IQR 60.5-72.4] vs 66.1 [IQR 58.7-70.6] years, P = .915). TBP-patients presented with greater surgical complexity (more concomitant procedures: 65.8% vs 45.8%, P = .041; chronic dissection: 18.4% vs 0.0%, P < .001; active infection at time of surgery: 15.8% vs 3.6%, P = .027). TBP reduced myocardial ischaemia time (median 65.0 [IQR 39.0-98.5] vs 122.0 [IQR 93.0-170.0] min, P < .001) and circulatory arrest use (18.4% vs 86.7%, P < .001), and demonstrated lower peak lactate levels (median 2.2 [IQR 1.5-4.6] vs 3.9 [IQR 2.9-5.2] mmol/L, P < .001), shorter ICU stay (median 2.0 [IQR 1.0-7.0] vs 4.0 [IQR 3.0-8.0] days, P = .006), and improved one-year survival (92.1% vs 72.3%, P = .025). Multivariable analysis confirmed TBP's independent survival benefit (HR = 0.187, 95% CI 0.044-0.807, P = .025). Sensitivity analyses were directionally consistent.
conclusionsTBP appeared as a feasible and safe approach in elective aortic arch surgery, associated with improved clinical outcomes and offering comprehensive organ protection. TBP may expand surgical candidacy in high-risk patients.
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