Is Hypothermic Circulatory arrest a risk factor for Patients with aortic Pathology?
Abstract
The paper describes the experience of the Ukrainian Children’s Cardiac Center (UCCC) of the Ministry of Health of Ukraine in the field of surgical treatment of patients with aortic pathology using hypothermic circulatory arrest (HCA).
The objective of this work was to analyze the outcomes and complications after surgical interventions on the ascending aorta and aortic arch using HCA.
Materials and methods. 122 patients with ascending aortic aneurysm and aortic arch aneurysm underwent surgical interventions at the UCCC in the period from 2012 to 2018. The patients were divided into 2 groups: study group including 33 patients who were exposed to HCA and comparison group including 89 patients without HCA.
Results. The incidence of postoperative complications in patients who were exposed to HCA technique was greater than that in patients who underwent surgical interventions without HCA. Stroke was detected only in 3% of patients exposed to HCA. The incidence of postoperative bleeding was significantly higher in patients who underwent HCA than in those without HCA (12% vs 2.2%, respectively). The incidence of wound infections was significantly higher in patients who underwent HCA than in those without using HCA (6% vs 0%, respectively).
Conclusion. HCA is associated with higher early postoperative mortality (9% vs 0%) and higher risk of postoperative complications, e.g. stroke, postoperative bleeding, wound infections, compared to surgical interventions without HCA. Patients who underwent HCA required transfusion of a greater number of blood components and longer duration of mechanical ventilation, longer stay in an intensive care unit and subsequent hospital stay compared to those without using HCA.
References
- Fernández Suárez FE, Fernández Del Valle D, González Alvarez A, Pérez-Lozano B. Intraoperative care for aortic surgery using circulatory arrest. J Thorac Dis. 2017 May;9(Suppl 6):S508–S520. https://doi.org/10.21037/jtd.2017.04.67
- Iba Y, Minatoya K, Matsuda H, Sasaki H, Tanaka H, Kobayashi J, Ogino H. Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair. J. Thorac. Cardiovasc. Surg. 2013;145:S72–7. https://doi.org/10.1016/j.jtcvs.2012.11.047
- Damberg A, Carino D, Charilaou P, Peterss S, Tranquilli M, Ziganshin BA, et al. Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest. J Thorac Cardiovasc Surg. 2017;154:1831–9.e1. https://doi.org/10.1016/j.jtcvs.2017.08.015
- Stewart JA, Ilkka VH, Jokinen JJ, Vakkuri AP, Suojaranta RT, Wennervirta J, Salminen US. Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery. Scand J Surg. 2018 Dec;107(4):322–8. https://doi.org/10.1177/1457496918766719
- Matalanis G, Perera NK, Galvin SD. Aortic arch replacement without circulatory arrest or deep hypothermia: The “branch-first” technique. J Thorac Cardiovasc Surg. 2015;149:S76–82. https://doi.org/10.1016/j.jtcvs.2014.07.100
- Schechter MA, Shah AA, Englum BR, Williams JB, Ganapathi AM, Davies JD, et al. Prolonged Postoperative Respiratory Support after Proximal Thoracic Aortic Surgery: Is Deep Hypothermic Circulatory Arrest a Risk Factor? J Crit Care. 2016 Feb;31(1):125–9. http://dx.doi.org/10.1016/j.jcrc.2015.10.021
- Yerokun BA, Karhausen J, Ranney DN, Benrashid E, Wang H, Keenan J, et al. Does Deeper Hypothermia Reduce the Risk of Acute Kidney Injury After Circulatory Arrest for Aortic Arch Surgery? [abstract]. Circulation.2017;136:A20760.
- Okita Y, Miyata H, Motomura N, Takamoto S; Japan Cardiovascular Surgery Database Organization. A study of brain protection during total arch replacement comparing antegrade cerebral perfusion versus hypothermic circulatory arrest, with or without retrograde cerebral perfusion: Analysis based on the Japan Adult Cardiovascular Surgery Database. The Journal of Thoracic and Cardiovascular Surgery. 2015;149(2):65–73. https://doi.org/10.1016/j.jtcvs.2014.08.070
- Mora Mangano CT, Neville MJ, Hsu PH, Mignea I, King J, Miller DC. Aprotinin, Blood Loss, and Renal Dysfunction in Deep Hypothermic Circulatory Arrest. Circulation. 2001 Sep 18;104(12 Suppl 1):I-276–I-281.
