Hypothermic Circulatory Arrest versus Aortic Clamping in Thoracic and Thoracoabdominal Aortic Aneurysm Repair

• Type of Material: Article
• Authors: Elizabeth Norton, Emory University; Felix Orelaru, St. Joseph Mercy; Rana-Armaghan Ahmad, Michigan Medicine, Ann Arbor; Jeffrey Clemence Jr., Michigan Medicine, Ann Arbor; Xiaoting Wu, Michigan Medicine, Ann Arbor; Karen M. Kim, Michigan Medicine, Ann Arbor; Shinichi Fukuhara, Michigan Medicine, Ann Arbor; Himanshu J. Patel, Michigan Medicine, Ann Arbor; Bo Yang, Michigan Medicine, Ann Arbor
• Language: English
• Date: 2022-11-02
• Publisher: John Wiley and Sons
• Publication Version: Preprint (Prior to Peer Review)
• Copyright Statement: © 2022 Wiley Periodicals LLC.
• Final Published Version (URL): https://doi.org/10.1111/jocs.17054
• Title of Journal or Parent Work: Journal of Cardiac Surgery
• Volume: 37
• Issue: 12
• Start Page: 4351
• End Page: 4358
• Grant/Funding Information: Dr. Yang is supported by the NHLBI of NIH K08HL130614, R01HL141891, and R01HL151776, Phil Jenkins and Darlene & Stephen J. Szatmari Funds.
• Keywords: thoracic aneurysm; aortic clamping; hypothermic circulatory arrest; paralysis; Thoracoabdominal aneurysm
• Research Categories: Health Sciences, Medicine and Surgery

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 with mild hypothermia (AC). Methods: From 2012–2021 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 minutes, p<0.0001) but shorter cross-clamp time (39 vs 120 minutes, p<0.0001) and lower temperatures (18 vs 34°C, p<0.0001). Postoperatively, the HCA group had longer intubation times (31 vs 26 hours, 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.