Nicholas T Kouchoukos1, Alexander Kulik2, Marc Haynes3, Catherine F Castner3. 1. Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri. Electronic address: ntk5611@bjc.org. 2. Division of Cardiothoracic Surgery, Lynn Heart and Vascular Institute, Boca Raton Regional Hospital, Boca Raton, Florida. 3. Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, BJC Healthcare, St Louis, Missouri.
Abstract
BACKGROUND: A variety of intraoperative strategies are currently used for organ protection during open operations on the thoracoabdominal aorta. We report our experience with cardiopulmonary bypass and hypothermic circulatory arrest as the primary modality for organ protection, focusing on the early outcomes. METHODS: During a 30-year interval, 285 patients underwent thoracoabdominal aortic aneurysm repair with the use of cardiopulmonary bypass with an interval of circulatory arrest (72 Crawford extent I, 107 extent II, 104 extent III, and 2 extent IV). Degenerative aneurysms were present in 72.6% and aortic dissections in 26.4% of patients. Emergent operations for rupture or acute dissection were required in 6.7% of the patients. RESULTS: Thirty-day mortality was 7.4% and was highest for the Crawford extent II and extent III patients (10.3% and 6.7%, respectively). Permanent paralysis or paraplegia occurred in 15 patients (5.3%). The rates were highest for the extent II and extent III patients (6.5% and 6.7%, respectively). Cerebrospinal fluid drainage had no impact on the development of spinal cord injury, and implantation of intercostal/lumbar arteries had a protective effect only in patients with extent II repair. Stroke occurred in 4.2% of patients and renal failure that required dialysis occurred in 6.2%. One-year actual survival was 90.4%. CONCLUSIONS: Our extended experience with this technique confirms its safety and effectiveness when used on a routine basis. The rates of spinal cord injury and permanent renal failure are among the lowest reported in the literature. Particularly favorable outcomes were observed in younger patients and patients undergoing elective operations.
BACKGROUND: A variety of intraoperative strategies are currently used for organ protection during open operations on the thoracoabdominal aorta. We report our experience with cardiopulmonary bypass and hypothermic circulatory arrest as the primary modality for organ protection, focusing on the early outcomes. METHODS: During a 30-year interval, 285 patients underwent thoracoabdominal aortic aneurysm repair with the use of cardiopulmonary bypass with an interval of circulatory arrest (72 Crawford extent I, 107 extent II, 104 extent III, and 2 extent IV). Degenerative aneurysms were present in 72.6% and aortic dissections in 26.4% of patients. Emergent operations for rupture or acute dissection were required in 6.7% of the patients. RESULTS: Thirty-day mortality was 7.4% and was highest for the Crawford extent II and extent III patients (10.3% and 6.7%, respectively). Permanent paralysis or paraplegia occurred in 15 patients (5.3%). The rates were highest for the extent II and extent III patients (6.5% and 6.7%, respectively). Cerebrospinal fluid drainage had no impact on the development of spinal cord injury, and implantation of intercostal/lumbar arteries had a protective effect only in patients with extent II repair. Stroke occurred in 4.2% of patients and renal failure that required dialysis occurred in 6.2%. One-year actual survival was 90.4%. CONCLUSIONS: Our extended experience with this technique confirms its safety and effectiveness when used on a routine basis. The rates of spinal cord injury and permanent renal failure are among the lowest reported in the literature. Particularly favorable outcomes were observed in younger patients and patients undergoing elective operations.