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Moderate to Deep Hypothermia in Patients Undergoing Thoracoabdominal Aortic Repair.

Abstract：

BACKGROUND:The aim of this study was to determine early and mid-term outcomes after open repair of thoracoabdominal aortic aneurysm, with moderate to deep hypothermia as part of proximal aortic management. METHODS:Between April 2009 and March 2015, 44 patients underwent thoracoabdominal aortic repair by total cardiopulmonary bypass at our institute. Our strategy was to use deep (<25°C) hypothermic circulatory arrest when open proximal anastomosis is necessary (n = 18). Otherwise, proximal anastomosis with an aortic clamp was performed with moderate (25-30°C) hypothermia without circulatory arrest (n = 26). Early and mid-term outcomes were assessed in all patients. RESULTS:In-hospital mortality was observed in 1 patient (2.3%). Stroke was observed in 2 (4.5%) patients and a spinal cord ischemic injury in 4 (9.1%). Renal failure requiring new hemodialysis was observed in 5 patients (11.4%). There were 9 patients (20.5%) with early major adverse events (in-hospital death, stroke, spinal cord ischemic injury, renal failure requiring new hemodialysis, and prolonged intubation). Multivariable logistic regression analysis demonstrated that a history of abdominal aortic aneurysm repair (odds ratio 17.711, 95% confidence interval 1.274-246.426, P = 0.032) was the only independent predictor of early major adverse events. Deep hypothermic circulatory arrest was not an independent predictor of early major adverse events. At 5 years, overall freedom from death was 89.4 ± 6.1%. CONCLUSION:Moderate to deep hypothermia as a constituent of proximal aortic management was safe and effective in patients undergoing open repair of thoracoabdominal aortic aneurysm.

journal_name

Ann Vasc Surg

journal_title

Annals of vascular surgery

authors

Fukui T,Takanashi S

doi

10.1016/j.avsg.2015.08.021

subject

Has Abstract

pub_date

2016-02-01 00:00:00

pages

39-45

eissn

0890-5096

issn

1615-5947

pii

S0890-5096(15)00807-9

journal_volume

31

pub_type

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