Comparative Analysis of Outcomes in Deep Hypothermic Circulatory Arrest and Left Heart Bypass Perfusion Techniques in Thoracic and Thoraco-Abdominal Aorta Repair

P0084 

Abstract Submission 

Ali Shan (1), Victoria Rizzo (1), Franziska Gorke (1), Muhammad Ashraf (1), Jason Kho (1), Michael M Sabetai (1), Morad Sallam (1), Amit Chawla (1), Roxanne Noces (1), Sunaina Mathapati (2)

(1) Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom, (2) Kings College London, London, United Kingdom

Ali Shan    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Victoria Rizzo    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Franziska Gorke    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Muhammad Ashraf    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Jason Kho    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Michael M Sabetai    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Morad Sallam    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Amit Chawla    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Roxanne Noces    -  Contact Me
Guy's & St Thomas' NHS Foundation Trust

Sunaina Mathapati    -  Contact Me
Kings College London

Ali Shan    -  Contact Me
N/A

Objective: Open thoraco-abdominal aortic aneurysm repair (TAAR) is a complex procedure with high mortality and complication rates. Different perfusion strategies have been developed to mitigate this risk of surgery. We evaluate and compare outcomes of deep hypothermic circulatory arrest (DHCA) and left heart bypass (LHB) in a decade of our experience as aortic referral centre.
Methods: Retrospective analysis of data included all consecutive patients who underwent TAAR from 2013 to September 2023. The analysed data includes demographics, pre-morbid clinical state, degree of aortic disease, perfusion strategy and post-operative complications. Primary outcomes measured were 30-day mortality and major complications including stroke, permanent neurologic deficit, renal dysfunction requiring dialysis and bowel ischemia.
Results: 120 consecutive adult patients who underwent thoracic or thoracoabdominal aorta repair were included with an average age of 60 years (range 22-84) with a male predominance (80.8%, 127). 17 (14.1%) patients had Marfan's syndrome and 3 (0.2%) had Loeys-Dietz syndrome. The average aneurysm size was 6.8 cm. 50% (60) of patients required cardio-pulmonary bypass, whereas 25% (30) required LHB. The average LHB time was 187.79 minutes (range 107-401) and the average DHCA time was 26 minutes (range 10-31). 30-day survival rate was 93.3% (112). The complication rate was 20.8% (25) with the most common being stroke (11, 9.2%), followed by paraplegia (9, 7.5%), post-operative dialysis (5, 4.2%) and bowel ischaemia (4, 3.3%). There was no significant difference between 30-day mortality (p=0.627, CI 95%) or complication rates (p=0.899, CI 95%) between our LHB and DHCA cohorts. No significant difference was identified for individual complications such as stroke, paraplegia, bowel ischaemia and post-operative dialysis in LHB and DHCA cohorts. Prolonged DHCA time was associated with an increase in complications (p=0.038, CI 95%). The most significant association of 30-day mortality was with poor pre-operative kidney function of Stage 3 or worse (rank correlation, p=0.032, CI95%, ρ (118) = 0.195).
Conclusion: Our study supports that DHCA is not inferior to LHB with no increase in 30-day mortality or complications between groups. Prolonged DHCA times increase the risk of complications; however, it had no effect on 30-day mortality. Pre-operative kidney dysfunction is a key risk factor in consideration of eligibility for surgery.

Descending/Thoracoabdominal Aorta