Abstract 11222: Surgical Repair of Descending Thoracic and Thoracoabdominal Aortic Aneurysm Involving Distal Arch: Open Proximal Anastomosis Under Deep Hypothermia versus Arch Clamping Technique
Background: Surgical repair of descending thoracic and thoracoabdominal aortic aneurysm (DTA/TAAA) involving the distal arch is challenging and requires either deep hypothermic circulatory arrest (DHCA) or cross-clamping the distal arch. The optimal technique for proximal control still remains controversial. We aimed to compare the outcomes between DHCA and arch clamping (AC) in DTA/TAAA involving the distal arch.
Methods: From 1994 to 2012, 298 patients underwent open repair of DTA/TAAA through left thoracotomy. Of these, 174, whose aortic pathology involved the distal arch but suitable for both DHCA (n = 81) and AC (n = 93), were analyzed (Figure-B). In-hospital outcomes were compared using propensity scores and inverse-probability-weighting adjustment to reduce treatment selection bias.
Results: Early mortality was 11.1% in the DHCA group and 8.6% in the AC group (P = 0.58). Major adverse outcomes included stroke in 16 patients (9.2%), low cardiac output syndrome in 15 (8.6%), paraplegia in 10 (5.7%), and multi-organ failure in 10 (5.7%). After adjustment, patients who underwent DHCA were at similar risk of death (OR, 1.13; P = 0.84) and permanent neurologic injury (OR, 1.05; P = 0.93) to those who underwent AC, but prolonged ventilator support (>24hr) was more frequent with DHCA than with AC (OR, 2.77; P = 0.007). However, DHCA showed a tendency to lower the risk of paraplegia (OR, 0.14; P = 0.057) (Table).
Conclusions: Compared with AC, DHCA did not increase major postoperative mortality and morbidity other than prolonged ventilator support. However, DHCA seemed to be associated with superior spinal cord protection than AC during repair of DTA/TAAA involving the distal arch.
- © 2013 by American Heart Association, Inc.