Outcomes after thoracoabdominal aortic aneurysm repair using hypothermic circulatory arrest.

Abstract

OBJECTIVE:

To evaluate our experience with thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass and hypothermic circulatory arrest.

METHODS:

A total of 243 patients underwent thoracoabdominal aortic aneurysm repair with full cardiopulmonary bypass and hypothermic circulatory arrest. The degree of repair was Crawford extent I in 63 (26%), Crawford extent II in 97 (40%), and Crawford extent III in 83 patients (34%). Degenerative aneurysms were the most frequent indication for surgery, and 18 patients (7.4%) required emergency surgery.

RESULTS:

The mean duration of cardiopulmonary bypass and hypothermic circulatory arrest was 160 ± 44 and 31 ± 12 minutes, respectively. Stroke occurred in 9 patients (3.7%) and spinal cord ischemic injury in 13 patients (5.3%; 9 with paraplegia and 4 with paraparesis). Temporary dialysis for new-onset renal failure was required in 3.6% of hospital survivors. The 30-day mortality rate was 7.8% (13 patients). It was 33.3% after emergency surgery and 5.6% after elective surgery (P = .001). Spinal cord ischemic injury occurred more frequently after emergency than after elective surgery (16.7% vs 3.9%; P = .04). The overall 5-year survival was 55% and was significantly better for patients with nondegenerative aortic disease.

CONCLUSIONS:

Cardiopulmonary bypass with hypothermic circulatory arrest can be safely used for thoracoabdominal aortic aneurysm repair, providing excellent protection against end-organ injury. The early and late mortality rates did not exceed those reported for other open techniques or for endovascular repair, with particularly favorable outcomes among patients undergoing elective repair.

• Authors: Nicholas T Kouchoukos, Alexander Kulik, Catherine F Castner
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 145 Issue 3 Suppl Pg. S139-41 (Mar 2013) ISSN: 1097-685X [Electronic] United States
• PMID: 23260438 (Publication Type: Journal Article)
• Copyright: Copyright © 2013 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)
• Elective Surgical Procedures
• Emergencies
• Female
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Paraparesis (etiology)
• Paraplegia (etiology)
• Renal Dialysis
• Renal Insufficiency (etiology, therapy)
• Risk Factors
• Spinal Cord Ischemia (etiology)
• Stroke (etiology)
• Time Factors
• Treatment Outcome
• Young Adult