Deep Hypothermic Circulatory Arrest in the Repair of Descending and Thoracoabdominal Aortic Aneurysms: Is It Safe?

P0096 

Abstract Submission 

joshua chen (1), Vishal Shah (1), Scott Koeneman (2), Jacqueline McGee (1), Megary McCoy (1), Colin King (1), Jeffrey Zucker (1), Konstadinos Plestis (1)

(1) Thomas Jefferson University Hospital, Philadelphia, PA, (2) Sidney Kimmel Medical College, Division of Biostatistics, Philadelphia, PA

joshua chen    -  Contact Me
Thomas Jefferson University Hospital

Vishal Shah    -  Contact Me
Thomas Jefferson University Hospital

Scott Koeneman    -  Contact Me
Sidney Kimmel Medical College, Division of Biostatistics

Jacqueline McGee    -  Contact Me
Thomas Jefferson University Hospital

Megary McCoy    -  Contact Me
Thomas Jefferson University Hospital

Colin King    -  Contact Me
Thomas Jefferson University Hospital

Jeffrey Zucker    -  Contact Me
Thomas Jefferson University Hospital

Konstadinos Plestis    -  Contact Me
Thomas Jefferson University Hospital

joshua chen    -  Contact Me
N/A

Objective:
Deep hypothermic circulatory arrest (DHCA) in patients undergoing descending (DTA) or thoracoabdominal aortic aneurysm (TAAA) repair is associated with increased morbidity, particularly pulmonary complications, and mortality. We present our outcomes after open DTA and TAAA repair with and without DHCA.

Methods:
We performed a retrospective review of a prospectively maintained aortic database. From 1998 to 2022, 267 patients underwent open DTA or TAAA repair by a single surgeon. Of these, 81 (30.3%) patients required DHCA because proximal cross-clamping was not feasible or aneurysmal pathology extended into the arch. The other 135 (50.6%) patients required either atrial-femoral bypass or femoral-femoral bypass. Of those that used atrial-femoral bypass, 30 (41.7%) patients had DTA repair and 42 (58.3%) patients had TAAA repair. Of those that used femoral-femoral bypass, 21 (31.3%) patients had DTA repair and 46 (68.6%) patients had TAAA repair. There were 59 (72.8%) DHCA patients and 86 (63.7%) non-DHCA patients with DTA or Crawford extent I TAAAs. The 51 (19.1%) patients who underwent surgery with the clamp-and-sew technique were excluded. Because of intrinsic pathological differences in patients requiring DHCA, confidence intervals were used to compare groups in lieu of p-values.

Results:
DHCA patients had more chronic dissections (64.2% vs 42.2%, 95% CI for difference: 0.08 - 0.36) and higher BMIs (29.5 ± 6.8 vs 27.3 ± 6.7, CI: 0.12 - 4.07). More non-DHCA patients had medial degeneration (9.9% vs 31.1%, CI: -0.33 - -0.07) and diabetes (11% vs 23%, CI: -0.23 - -0.01). There were 10 (12.4%) in-hospital deaths for the DHCA and 10 (7.4%) for the non-DHCA group (CI: -0.04 - 0.14). There were 4 (4.9%) in the DHCA and 5 (3.7%) in the non-DHCA group that developed stroke (CI: -0.05 - 0.08). Two (2.5%) patients in the DHCA group and two (1.5%) patients in the non-DHCA group developed permanent paraplegia (CI: -0.04 - 0.06). Three (3.7%) in the DHCA and nine (6.7%) in the non-DHCA group developed renal failure requiring dialysis (CI: -0.10 - 0.04). There were no differences in the incidence of pulmonary complications, particularly prolonged ventilation (>48 hours) (46.3% vs 36.3%, CI: -0.04 - 0.25), pneumonia (17.3% vs 12.9%, CI: -0.05 - 0.16), or tracheostomy (12.4% vs 13.3%, CI: -0.11 - 0.09) between DHCA and non-DHCA, respectively. The only meaningful differences in postoperative outcomes were ICU (5.5 (IQR: 3-19.75) days vs 6 (IQR: 4-10) days, CI: 0.43-9.0) and hospital length of stays (19 (IQR: 11-29) days vs 12 (IQR: 10-19) days, CI: 2.4-14.2), which were both longer in the DHCA group (Table 1).

Conclusions:
Despite longer ICU and hospital length of stays, DHCA is safe and effective with comparable morbidity and mortality to non-DHCA in open DTA and TAAA repair.

Descending/Thoracoabdominal Aorta