Circulatory Arrest Time Above 30 Minutes have Significantly Detrimental Effects on the Outcomes of Type A Aortic Dissection Repair

P0080 

Abstract Submission 

Anthony Lemaire (1), Sorasicha Nithikasem (2), Abhishek Chakraborty (3), Alex Rahimi (1), Mark Russo (4), Leonard Lee (5)

(1) Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, (2) Rutgers Robert Wood Johnson Medical School, United States, (3) Le Bonheur Children's Hospital, Memphis, TN, (4) Robert Wood Johnson University Hospital, Green Village, NJ, (5) Robert Wood Johnson University Hospital, New Brunswick, NJ

*Anthony Lemaire    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Sorasicha Nithikasem    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Abhishek Chakraborty    -  Contact Me
Le Bonheur Children's Hospital

Alex Rahimi    -  Contact Me
Rutgers Robert Wood Johnson Medical School

*Mark Russo    -  Contact Me
Robert Wood Johnson University Hospital

*Leonard Lee    -  Contact Me
Robert Wood Johnson University Hospital

*Anthony Lemaire    -  Contact Me
Rutgers Robert Wood Johnson Medical School

Objective:
Acute aortic dissection of the ascending aorta is a life-threatening disease that poses a challenge for cardiovascular surgeons. Surgical repair involves the use of hypothermic circulatory arrest (HCA) for proximal aortic repair. The impact of circulatory arrest duration on postoperative outcomes is unclear. The purpose of this study is to determine the pivotal circulatory arrest time that increases surgical complications.
Methods: This retrospective review of prospectively collected data included patients who underwent Aortic Dissection Repair from 2016- 2022 at a single academic institution. Circulatory arrest time groups were stratified by above and below 30 minutes. Outcomes were compared across cerebral perfusion modalities and hypothermic temperatures with confounds controlled to ascertain independent effect. Primary outcomes included 30-Day mortality, and postoperative length of stay. Outcomes were analyzed using Pearson's Chi-squared, Fisher's Exact, Multiple Regression Analysis and Pooled T-Tests, with significance set at p<0.05.
Results: A total of 142 patients were included, 117 of whom (82%) had arrest times below 30 minutes and 25 (18%) had arrest times above 30 minutes. There were no differences in preoperative baseline characteristics. There were differences in Cardiopulmonary Bypass Time (P < .001) and Cross Clamp Time (P = .036). Patients with circulatory arrest times less than 30 minutes had less cerebrovascular accident (CVA) (P < .001) and less 30 Day (P < .001) and 12 Month Mortality (P = .002). Confound controlled multifactorial regression (CCMR) confirmed continuous circulatory arrest time as the sole independent effect on CVA (P=.002) in a model with cerebral perfusion modality, circulatory arrest time and hypothermic temperature. CCMR found no independent effect of neuroprotectant deep hypothermic temperature (P=.360) or cerebral perfusion technique (no perfusion vs retrograde vs anterograde) (P=.321) during circulatory arrest on incidence of CVA. CCMR did find that circulatory arrest time (P< .001) and use of retrograde cerebral perfusion (P=.040) to be independently predictive of 30 Day and 12 Month Mortality (Both | P=.003). Retrograde cerebral perfusion (P=.012) was additionally found predictive of postoperative pericardial and pleural effusions.
Conclusions: Longer circulatory arrest duration greater than 30 minutes leads to worse outcomes despite cooling temperature and method of neuroprotection.

Cerebral Protection