Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair

被引:6
|
作者
Norton, Elizabeth L. [1 ]
Orelaru, Felix [2 ]
Ahmad, Rana-Armaghan [3 ]
Clemence, Jeffrey, Jr. [3 ]
Wu, Xiaoting [3 ]
Kim, Karen M. [3 ]
Fukuhara, Shinichi [3 ]
Patel, Himanshu J. [3 ]
Yang, Bo [3 ]
机构
[1] Emory Univ, Dept Cardiothorac Surg, Atlanta, GA USA
[2] St Joseph Mercy, Dept Gen Surg, Ann Arbor, MI USA
[3] Michigan Med, Dept Cardiac Surg, 1500 East Med Ctr Dr,5155 Franke Cardiovasc Ctr, Ann Arbor, MI 48109 USA
基金
美国国家卫生研究院;
关键词
aortic clamping; hypothermic circulatory arrest; paralysis; thoracic aneurysm; thoracoabdominal aneurysm; PROTECTION; OPERATIONS; OUTCOMES;
D O I
10.1111/jocs.17054
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background To compare perioperative and midterm outcomes in thoracic and thoraco-abdominal aortic aneurysm (TAA and TAAA) repair using hypothermic circulatory arrest (HCA) or aortic clamping (AC) with mild hypothermia. Methods From 2012 to 2021 there were 180 open repairs of a TAA or TAAA, of which 90 (50%) were done with HCA and 90 (50%) with aortic clamping with mild hypothermia. The indications for HCA were arch aneurysm, TAA from chronic aortic dissection, and inability to clamp the aorta for proximal anastomosis. Results Compared to AC, the HCA group had less prior descending aorta replacement/repair (9.1% vs. 32%, p = 0.0001). Intraoperatively, the HCA group had more TAAs (70% vs. 20%, p < 0.0001) while the AC group had more TAAAs (80% vs. 30%, p < 0.0001). HCA group had longer cardiopulmonary bypass times (242 vs. 181 min, p < 0.0001) but shorter cross-clamp time (39 vs. 120 min, p < 0.0001) and lower temperatures (18 degrees C vs. 34 degrees C, p < 0.0001). Postoperatively, the HCA group had longer intubation times (31 vs. 26 h, p = 0.002), but all other postoperative outcomes including paralysis (2.2% vs. 8.9%, p = 0.08), and operative mortality (4.4% vs. 2.2%, p = 0.68) were similar between HCA and AC groups. Patient age was an independent risk factor for postoperative paralysis (OR 1.07, p = 0.03) while HCA was not significant (OR 0.37, p = 0.21). Five-year survival was similar between HCA and AC groups (85% vs. 80%, p = 0.36). Conclusions Postoperative outcomes and midterm survival were acceptable in thoracic and thoracoabdominal aneurysm patients after HCA or AC. Both HCA and AC with mild hypothermia were valid approaches in TAA/A repair.
引用
收藏
页码:4351 / 4358
页数:8
相关论文
共 50 条
  • [21] Veno-venous perfusion to cool and rewarm in thoracic and thoracoabdominal aortic aneurysm repair
    Schmidt, Christian A. P.
    Wilhelm, Markus J.
    Mayer, Dieter O.
    Rancic, Zoran
    Bangemann, Annette
    Felix, Christian
    Veith, Frank J.
    Lachat, Mario L.
    JOURNAL OF VASCULAR SURGERY, 2013, 58 (01) : 33 - 41
  • [22] Assessment of intraoperative motor evoked potentials for predicting postoperative paraplegia in thoracic and thoracoabdominal aortic aneurysm repair
    Horiuchi, Toshinori
    Kawaguchi, Masahiko
    Inoue, Satoki
    Hayashi, Hironobu
    Abe, Ryuichi
    Tabayashi, Nobuoki
    Taniguchi, Shigeki
    Furuya, Hitoshi
    JOURNAL OF ANESTHESIA, 2011, 25 (01) : 18 - 28
  • [23] Outcomes of Open Versus Endovascular Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysms
    Tong, Michael Z.
    Eagleton, Matthew J.
    Roselli, Eric E.
    Blackstone, Eugene H.
    Xiang, Fei
    Ibrahim, Mudathir
    Johnston, Douglas R.
    Soltesz, Edward G.
    Bakaeen, Faisal G.
    Lyden, Sean P.
    Toth, Andrew J.
    Liu, Huan
    Svensson, Lars G.
    ANNALS OF THORACIC SURGERY, 2022, 113 (04): : 1144 - 1152
  • [24] Impact of brain protection strategies on mortality and stroke in patients undergoing aortic arch repair with hypothermic circulatory arrest: evidence from the Canadian Thoracic Aortic Collaborative
    Hage, Ali
    Stevens, Louis-Mathieu
    Ouzounian, Maral
    Chung, Jennifer
    El-Hamamsy, Ismail
    Chauvette, Vincent
    Dagenais, Francois
    Cartier, Andreanne
    Peterson, Mark D.
    Boodhwani, Munir
    Guo, Ming
    Bozinovski, John
    Moon, Michael C.
    White, Abigail
    Kumar, Kanwal
    Lodewyks, Carly
    Bittira, Bindu
    Payne, Darrin
    Chu, Michael W. A.
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2020, 58 (01) : 95 - 103
  • [25] Endovascular Repair versus Open Repair for Isolated Descending Thoracic Aortic Aneurysm
    Lee, Hyung Chae
    Joo, Hyun-Chel
    Lee, Seung Hyun
    Lee, Sak
    Chang, Byung-Chul
    Yoo, Kyung-Jong
    Youn, Young-Nam
    YONSEI MEDICAL JOURNAL, 2015, 56 (04) : 904 - 912
  • [26] Is aortic surgery using hypothermic circulatory arrest in octogenarians justifiable?
    Hagl, C
    Galla, JD
    Spielvogel, D
    Lansman, SL
    Squitieri, R
    Bodian, CA
    Ergin, MA
    Griepp, RB
    EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2001, 19 (04) : 417 - 422
  • [27] Thoracoabdominal aortic aneurysm repair: current endovascular perspectives
    Orr, Nathan
    Minion, David
    Bobadilla, Joseph L.
    VASCULAR HEALTH AND RISK MANAGEMENT, 2014, 10 : 493 - 505
  • [28] Open thoracoabdominal aortic aneurysm repair in the endovascular era
    Tanaka, Akiko
    Charlton-Ouw, Kristofer M.
    ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2020, 27 (01): : 69 - 75
  • [29] Total arch replacement versus debranching thoracic endovascular aortic repair for an aortic arch aneurysm
    Chiba, Kiyoshi
    Nishimaki, Hiroshi
    Tomita, Masahiro
    Nakamura, Ryuji
    Kinebuchi, Satoshi
    Kita, Shota
    Komagamine, Masahide
    Tanigawa, Kazuyoshi
    Nawata, Kan
    Chikada, Masahide
    Miyairi, Takeshi
    ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY, 2023, 30 (02): : 21 - 30
  • [30] Endovascular Repair of Thoracoabdominal Aortic Aneurysm: A Brief Review
    Tohme, Scarlett
    Newman, Joshua
    Yu, Pey-Jen
    INTERNATIONAL JOURNAL OF ANGIOLOGY, 2024, 33 (04) : 222 - 228