Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair

Abstract

Background To compare perioperative and midterm outcomes in thoracic and thoraco‐abdominal aortic aneurysm (TAA and TAAA) repair using hypothermic circulatory arrest (HCA) or aortic clamping (AC) with mild hypothermia. Methods From 2012 to 2021 there were 180 open repairs of a TAA or TAAA, of which 90 (50%) were done with HCA and 90 (50%) with aortic clamping with mild hypothermia. The indications for HCA were arch aneurysm, TAA from chronic aortic dissection, and inability to clamp the aorta for proximal anastomosis. Results Compared to AC, the HCA group had less prior descending aorta replacement/repair (9.1% vs. 32%, p = 0.0001). Intraoperatively, the HCA group had more TAAs (70% vs. 20%, p < 0.0001) while the AC group had more TAAAs (80% vs. 30%, p < 0.0001). HCA group had longer cardiopulmonary bypass times (242 vs. 181 min, p < 0.0001) but shorter cross‐clamp time (39 vs. 120 min, p < 0.0001) and lower temperatures (18°C vs. 34°C, p < 0.0001). Postoperatively, the HCA group had longer intubation times (31 vs. 26 h, p = 0.002), but all other postoperative outcomes including paralysis (2.2% vs. 8.9%, p = 0.08), and operative mortality (4.4% vs. 2.2%, p = 0.68) were similar between HCA and AC groups. Patient age was an independent risk factor for postoperative paralysis (OR 1.07, p = 0.03) while HCA was not significant (OR 0.37, p = 0.21). Five‐year survival was similar between HCA and AC groups (85% vs. 80%, p = 0.36). Conclusions Postoperative outcomes and midterm survival were acceptable in thoracic and thoracoabdominal aneurysm patients after HCA or AC. Both HCA and AC with mild hypothermia were valid approaches in TAA/A repair.

Comparison of Immediate, Medium, and Long-Term Postoperative Results of Open Surgery and Fenestrated/Branched Stent Grafts for Extended Thoracoabdominal Aortic Aneurysms

“…Surgical techniques and adjuncts have been developed over the years to reduce end-organ and spinal cord ischemia (SCI). They include extracorporeal circulation with distal perfusion and sequential aortic clamping [6][7][8][9][10], selective visceral and renal perfusion with blood or cold crystalloid [11][12][13], hypothermia [14][15][16][17], intercostal artery reimplantation [18][19][20], perioperative monitoring of spinal cord function using motor-evoked potentials and somatosensory-evoked potentials [21][22][23][24], and cerebrospinal fluid drainage [25,26].…”

Management of Thoracoabdominal Aortic Aneurysms

“…Mortality rates for patients undergoing TAAA repair and descending thoracic aortic aneurysms fluctuate significantly, observed within a range of 4-21% [9,[42][43][44]. This variation in outcomes can be attributed to the diversity within the patient demographics and the varying levels of expertise among the medical teams.…”

Cool-Shot Technique to Protect Spinal Cord during Thoracoabdominal Aortic Replacement

“…Spinal cord injury (SCI) is one of the complications that surgeons must seriously avoid in patients undergoing thoracic and abdominal aortic aneurysm (TAAA) repair, causing permanent paralysis at a rate of 2.0-10.8% [1][2][3][4].…”