Abstract | OBJECTIVE: METHODS: From January 1986 to December 2008, 218 patients (mean age, 63 ± 14 years) underwent thoracoabdominal aortic aneurysm repair with cardiopulmonary bypass and hypothermic circulatory arrest. The degree of repair was as follows: Crawford extent I, 57 (26%) patients; Crawford extent II, 91 (41%) patients; and Crawford extent III, 70 (32%) patients. Degenerative aneurysms were present in 160 (73%) patients. Eighteen (8%) patients underwent emergency operations. RESULTS: The mean durations of cardiopulmonary bypass and hypothermic circulatory arrest were 160 ± 44 and 31 ± 12 minutes, respectively. Stroke occurred in 8 (3.7%) patients, and spinal cord ischemic injury occurred in 10 (4.6%) patients (8 with paraplegia and 2 with paraparesis). Temporary dialysis for new-onset renal failure was required in 3.6% of hospital survivors. Thirty-day and 1-year mortality rates were 7.3% and 24.5%, respectively. After emergency operations, the 30-day mortality rate was 33.3% compared with 5.0% after elective operations (P = .001). Five- and 10-year survivals were 55% and 23%, respectively. Twenty-five patients required reoperation on the graft or contiguous aorta at a mean of 5 ± 3 years after the initial procedure. Five- and 10-year rates of freedom from reoperation were 87% and 60%, respectively. CONCLUSIONS:
Cardiopulmonary bypass with hypothermic circulatory arrest can be safely used for thoracoabdominal aortic aneurysm repair, providing excellent protection against end-organ injury. Early mortality and morbidity rates do not exceed those reported for endovascular repair, with particularly favorable outcomes among patients undergoing elective operations.
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Authors | Alexander Kulik, Catherine F Castner, Nicholas T Kouchoukos |
Journal | The Journal of thoracic and cardiovascular surgery
(J Thorac Cardiovasc Surg)
Vol. 141
Issue 4
Pg. 953-60
(Apr 2011)
ISSN: 1097-685X [Electronic] United States |
PMID | 20621310
(Publication Type: Journal Article)
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Copyright | Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved. |
Topics |
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Aortic Aneurysm, Thoracic
(mortality, surgery)
- Blood Vessel Prosthesis Implantation
(adverse effects, mortality)
- Cardiopulmonary Bypass
- Circulatory Arrest, Deep Hypothermia Induced
(adverse effects, mortality)
- Female
- Hospital Mortality
- Humans
- Kaplan-Meier Estimate
- Logistic Models
- Male
- Middle Aged
- Odds Ratio
- Paraplegia
(etiology)
- Renal Dialysis
- Renal Insufficiency
(etiology, therapy)
- Reoperation
- Retrospective Studies
- Risk Assessment
- Risk Factors
- Spinal Cord Ischemia
(etiology)
- Stroke
(etiology)
- Time Factors
- Treatment Outcome
- Young Adult
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