Dataset Information

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair.

ABSTRACT:

Objective

To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair.

Methods

We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods. Incremental effect of cooling time was assessed in the context of other perfusion time variables using multiple logistic regression analysis.

Results

Median age was 61 years (interquartile range, 49-70 years) and 34.1% of patients were women. The procedure was emergent in 33.5% of patients, 22.9% had a previous sternotomy. The median circulatory arrest time was 22 minutes, with retrograde cerebral perfusion used in 94% of cases. Median cardiopulmonary bypass time was 149 minutes, with an aortic crossclamp time of 90 minutes. Patients were cooled to deep hypothermia. The first quartile had cooling times ranging from 5 to 13 minutes, second 14 to 18 minutes, third 19-23 minutes, and fourth 24-81 minutes. Overall, 30-day mortality was 9.4%, and was not significantly different across quartiles. There was a statistically significant trend toward lower rates of postoperative encephalopathy, gastrointestinal complications, and respiratory failure with shorter cooling times (P < .001, .006, and < .001, respectively). There was no significant difference in rates of postoperative stroke or dialysis.

Conclusions

Rapid cooling can be performed safely in patients undergoing aortic surgery requiring circulatory arrest without increasing mortality or stroke. There were significantly lower rates of coagulopathy, respiratory failure, and postoperative encephalopathy with shorter cooling times.

SUBMITTER: Smith HN

PROVIDER: S-EPMC9737039 | biostudies-literature | 2022 Dec

REPOSITORIES: biostudies-literature

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Publications

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair.

Smith Holly N HN Tanaka Akiko A Chehadi Max M Sandhu Harleen K HK Miller Charles C CC Safi Hazim J HJ Estrera Anthony L AL

JTCVS techniques 20221019

<h4>Objective</h4>To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair.<h4>Methods</h4>We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods. Incremental effect of cooling time was assessed in t ...[more]

PMID: 36510530

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Project description:BackgroundThe ideal technique of cerebral protection in the surgical operation of the ascending aorta.is currently controversial. The current analysis evaluates the influence of moderate hypothermic circulatory arrest (MHCA) on elective replacement of the ascending aorta.MethodsThe study included 905 consecutive patients between 2001 and 2015, who underwent replacement of ascending aorta in MHCA. Patients were divided according to the postoperative 30-day mortality into survivor und non-survivor group.ResultsThe average age was 66.5±11.1 in survivors vs. 70.0±10.5 years in non-survivors (P=0.057). The survivor group had a significantly lower Euro-SCORE II than non-survivors [4.0% (2.3, 6.6) vs. 9.5% (4.8, 20.9); P<0.001)]. The incidence of coronary heart disease (38.0% vs. 58.3%; P=0.022) and chronic renal failure (10.0% vs. 33.3%, P<0.001 was significantly higher in non-survivors. Intraoperatively, the cardiopulmonary bypass time [140 min (112, 185) vs. 194 min (164, 271); P<0.001] and cross-clamping time [91 min (64, 124) vs.119 min (94, 157); P<0.001] were significantly longer in non-survivors. However, the MHCA time was similar in both groups with statistical significance (P=0.023). Postoperatively, re-exploration due to bleeding was highly significant in non-survivors (5.4% vs. 33.3%; P<0.001) with a higher incidence of stroke (4.6% vs. 33.3%; P<0.001). The duration of mechanical ventilation was significantly shorter in survivors than in non-survivors [17 h (12, 26) vs. 147 h (49, 337); P<0.001] with a lower incidence of pulmonary infection (6.0% vs.16.7%; P=0.023). The multivariable logistic regression analysis showed age, female gender, aortic aneurysm, additional CABG, total arch replacement and cardiopulmonary bypass time were independent risk factors for 30-day mortality.ConclusionsThe acceptable morbidity and mortality rates show that MHCA can be considered as a safe technique for cerebral protection in surgical replacement of thoracic aorta.

Project description:BACKGROUND:Various studies evaluated the relationship between hypothermic circulatory arrest and neurological outcome in patients undergoing replacement of ascending aorta. The current analysis focuses on the effect of moderate hypothermic circulatory arrest (MHCA) on elderly patients. The aim of our study was to evaluate the impact of MHCA on neurological outcomes in elderly patients undergoing replacement of the ascending aorta. RESULTS:We retrospectively analyzed 905 consecutive patients, who underwent elective replacement of ascending aorta in MHCA (24?±?2?°C, nasopharyngeal) between 2001 and 2015. Patients with acute aortic dissection were excluded from this study. Patients were divided into two groups: those aged 75?years and older (elderly group 22.4%, n?=?203) and those younger than 75?years (younger group 77.6%, n?=?702). The average age was 63.2?±?10.2 in the young group vs. 78.7?±?3.0?years in elderly group (p?<?0.001). The elderly group had a significantly higher EuroSCORE II [26.7% (18.1, 36.3) vs. 11.6% (7.4, 19.9); p?<?0.001)]. The incidence of coronary heart disease (49.8% vs. 35.6%, p?<?0.001) and chronic renal failure (17.2% vs. 9.1%, p?=?0.001) was significantly higher in the elderly group. Intraoperatively, the time of MHCA [14?min (12, 17) vs. 15?min (12, 18); p?=?0.42], cardiopulmonary bypass [139?min (110, 183) vs. 144?min (113, 189); p?=?0.225], and cross-clamping [91?min (63, 116) vs. 92?min (65, 127); p?=?0.348] was similar in both groups. Postoperatively, a higher incidence of delirium was significantly reported in the elderly group (24.1% vs. 9.0%, p?<?0.001). However, there was no significant difference regarding neurological complications between both groups. A 30-day mortality was acceptable for the elderly group, but significantly higher compared with the younger group (7.1% vs. 3.5%, p?=?0.031). CONCLUSIONS:Our study suggests that surgical replacement of the ascending aorta in MHCA can also be applied safely in elderly patients without increasing the risk of severe neurological complications.

Dataset Information

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair.

Objective

Methods

Results

Conclusions

Publications

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair.

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