{"title":"Outcomes of Deep Hypothermic Circulatory Arrest for Descending and Thoracoabdominal Aneurysm Repair","authors":"","doi":"10.1016/j.avsg.2024.07.096","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Deep hypothermic circulatory arrest (DHCA) in patients undergoing descending thoracic (DTAA) or thoracoabdominal aortic aneurysm (TAAA) repair is associated with increased morbidity and mortality. We present our outcomes after open DTAA and TAAA repair with and without DHCA.</p></div><div><h3>Methods</h3><p>From 1999 to 2022, 81 (38.8%) patients undergoing DTAA or TAAA repair required DHCA because proximal cross-clamping was not feasible or aneurysmal pathology extended into the arch and 128 (61.2%) patients required only distal bypass. Because of intrinsic pathological differences in patients requiring DHCA, confidence intervals (CIs) were used to compare groups in lieu of formal hypothesis tests.</p></div><div><h3>Results</h3><p>DHCA patients had more chronic dissections (64.2% vs. 43.8%, 95% CI for difference: 6–35%) and higher body mass indices (29.5 ± 6.8 vs. 27.2 ± 6.6, CI: 26–421%). More non-DHCA patients had medial degeneration (9.9% vs. 31.3%, CI: −33 to −7%). There were 10 (12.4%) in-hospital deaths for the DHCA and 10 (7.8%) for the non-DHCA group (CI: −5 to 14%). Survival at 10 years was 52.6% (CI: 42.1–65.7%) for the non-DHCA group and 48.3% (CI: 40.3–57.9%) for the DHCA group. The only meaningful differences in postoperative outcomes were intensive care unit (5.5 days vs. 6 days, CI: 12–410%) and hospital stay (19 days vs. 12 days, CI: 74–470%), which were longer in the DHCA group.</p></div><div><h3>Conclusions</h3><p>Despite longer intensive care unit and hospital length of stays, selective use of DHCA is safe and effective with comparable morbidity and mortality to non-DHCA in open DTAA and TAAA repair.</p></div>","PeriodicalId":8061,"journal":{"name":"Annals of vascular surgery","volume":null,"pages":null},"PeriodicalIF":1.4000,"publicationDate":"2024-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of vascular surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S089050962400493X","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"PERIPHERAL VASCULAR DISEASE","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Deep hypothermic circulatory arrest (DHCA) in patients undergoing descending thoracic (DTAA) or thoracoabdominal aortic aneurysm (TAAA) repair is associated with increased morbidity and mortality. We present our outcomes after open DTAA and TAAA repair with and without DHCA.
Methods
From 1999 to 2022, 81 (38.8%) patients undergoing DTAA or TAAA repair required DHCA because proximal cross-clamping was not feasible or aneurysmal pathology extended into the arch and 128 (61.2%) patients required only distal bypass. Because of intrinsic pathological differences in patients requiring DHCA, confidence intervals (CIs) were used to compare groups in lieu of formal hypothesis tests.
Results
DHCA patients had more chronic dissections (64.2% vs. 43.8%, 95% CI for difference: 6–35%) and higher body mass indices (29.5 ± 6.8 vs. 27.2 ± 6.6, CI: 26–421%). More non-DHCA patients had medial degeneration (9.9% vs. 31.3%, CI: −33 to −7%). There were 10 (12.4%) in-hospital deaths for the DHCA and 10 (7.8%) for the non-DHCA group (CI: −5 to 14%). Survival at 10 years was 52.6% (CI: 42.1–65.7%) for the non-DHCA group and 48.3% (CI: 40.3–57.9%) for the DHCA group. The only meaningful differences in postoperative outcomes were intensive care unit (5.5 days vs. 6 days, CI: 12–410%) and hospital stay (19 days vs. 12 days, CI: 74–470%), which were longer in the DHCA group.
Conclusions
Despite longer intensive care unit and hospital length of stays, selective use of DHCA is safe and effective with comparable morbidity and mortality to non-DHCA in open DTAA and TAAA repair.
期刊介绍:
Annals of Vascular Surgery, published eight times a year, invites original manuscripts reporting clinical and experimental work in vascular surgery for peer review. Articles may be submitted for the following sections of the journal:
Clinical Research (reports of clinical series, new drug or medical device trials)
Basic Science Research (new investigations, experimental work)
Case Reports (reports on a limited series of patients)
General Reviews (scholarly review of the existing literature on a relevant topic)
Developments in Endovascular and Endoscopic Surgery
Selected Techniques (technical maneuvers)
Historical Notes (interesting vignettes from the early days of vascular surgery)
Editorials/Correspondence