Surgical repair of descending thoracic and thoracoabdominal aortic aneurysm involving the distal arch: open proximal anastomosis under deep hypothermia versus arch clamping technique.

Abstract

BACKGROUND:

Surgical repair of a descending thoracic and thoracoabdominal aortic aneurysm (DTA/TAAA) involving the distal arch is challenging and requires either deep hypothermic circulatory arrest (DHCA) or crossclamping of the distal arch. The aim of this study was to compare these 2 techniques in the treatment of DTA/TAAA involving the distal arch.

METHODS:

From 1994 to 2012, 298 patients underwent open repair of DTA/TAAA through a left thoracotomy. One hundred seventy-four patients with distal arch involvement who were suitable for either DHCA (n=81) or arch clamping (AC; n=93), were analyzed. In-hospital outcomes were compared using propensity scores and inverse-probability-of-treatment weighting adjustment to reduce treatment selection bias.

RESULTS:

Early mortality was 11.1% in the DHCA group and 8.6% in the AC group (P=.58). Major adverse outcomes included stroke in 16 patients (9.2%), low cardiac output syndrome in 15 (8.6%), paraplegia in 10 (5.7%), and multiorgan failure in 10 (5.7%). After adjustment, patients who underwent DHCA were at similar risk of death (odds ratio [OR], 1.14; P=.80) and permanent neurologic injury (OR, 0.95; P=.92) to those who underwent AC. Although prolonged ventilator support (>24 hours) was more frequent with DHCA than with AC (OR, 2.60; P=.003), DHCA showed a tendency to lower the risk of paraplegia (OR, 0.15; P=.057).

CONCLUSIONS:

Compared with AC, DHCA did not increase postoperative mortality and morbidity, except for prolonged ventilator support. However, DHCA may offer superior spinal cord protection to AC during repair of DTA/TAAA involving the distal arch.

• Authors: Jae Suk Yoo, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 148 Issue 5 Pg. 2101-7 (Nov 2014) ISSN: 1097-685X [Electronic] United States
• PMID: 25131174 (Publication Type: Comparative Study, Journal Article, Observational Study)
• Copyright: Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Aorta, Thoracic (surgery)
• Aortic Aneurysm, Thoracic (diagnosis, mortality, surgery)
• Blood Vessel Prosthesis Implantation (adverse effects, methods, mortality)
• Chi-Square Distribution
• Circulatory Arrest, Deep Hypothermia Induced (adverse effects, mortality)
• Constriction
• Female
• Humans
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Postoperative Complications (mortality, therapy)
• Propensity Score
• Retrospective Studies
• Risk Factors
• Thoracotomy
• Time Factors
• Treatment Outcome