Early Outcomes After Thoracoabdominal Aortic Aneurysm Repair With Hypothermic Circulatory Arrest
| Autor: | Alexander Kulik, Nicholas T. Kouchoukos, Marc Haynes, Catherine F. Castner |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Time Factors medicine.medical_treatment 030204 cardiovascular system & hematology law.invention 03 medical and health sciences Aortic aneurysm Postoperative Complications 0302 clinical medicine law medicine.artery medicine Cardiopulmonary bypass Humans Stroke Spinal cord injury Dialysis Aged Retrospective Studies Aged 80 and over Cardiopulmonary Bypass Aortic Aneurysm Thoracic business.industry Middle Aged medicine.disease Surgery Circulatory Arrest Deep Hypothermia Induced Treatment Outcome 030228 respiratory system Cardiothoracic surgery Cardiology and Cardiovascular Medicine Paraplegia business Vascular Surgical Procedures Lumbar arteries |
| Zdroj: | The Annals of Thoracic Surgery. 108:1338-1343 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2019.04.014 |
| Popis: | Background A variety of intraoperative strategies are currently used for organ protection during open operations on the thoracoabdominal aorta. We report our experience with cardiopulmonary bypass and hypothermic circulatory arrest as the primary modality for organ protection, focusing on the early outcomes. Methods During a 30-year interval, 285 patients underwent thoracoabdominal aortic aneurysm repair with the use of cardiopulmonary bypass with an interval of circulatory arrest (72 Crawford extent I, 107 extent II, 104 extent III, and 2 extent IV). Degenerative aneurysms were present in 72.6% and aortic dissections in 26.4% of patients. Emergent operations for rupture or acute dissection were required in 6.7% of the patients. Results Thirty-day mortality was 7.4% and was highest for the Crawford extent II and extent III patients (10.3% and 6.7%, respectively). Permanent paralysis or paraplegia occurred in 15 patients (5.3%). The rates were highest for the extent II and extent III patients (6.5% and 6.7%, respectively). Cerebrospinal fluid drainage had no impact on the development of spinal cord injury, and implantation of intercostal/lumbar arteries had a protective effect only in patients with extent II repair. Stroke occurred in 4.2% of patients and renal failure that required dialysis occurred in 6.2%. One-year actual survival was 90.4%. Conclusions Our extended experience with this technique confirms its safety and effectiveness when used on a routine basis. The rates of spinal cord injury and permanent renal failure are among the lowest reported in the literature. Particularly favorable outcomes were observed in younger patients and patients undergoing elective operations. |
| Databáze: | OpenAIRE |
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