Risk Analysis for Perioperative Stroke after Crawford Extent I or II Aortic Repair with Deep Hypothermic Circulatory Arrest

P0291 

Abstract Submission 

Hiroaki Osada (1), Kenji Minatoya (1), Haruka Fujimoto (1), Yasuyuki Fujimoto (1), Hiromasa Kira (1), Kazuhiro Takatoku (1), Kazuyoshi Kanno (1), Masahide Kawatou (1), Fumie Takai (1), Takahide Takeda (1), Takehiko Matsuo (1), Tadashi Ikeda (1)

(1) Kyoto University, Graduate School of Medicine, Kyoto, Japan

Hiroaki Osada    -  Contact Me
Kyoto University, Graduate School of Medicine

*Kenji Minatoya    -  Contact Me
Kyoto University, Graduate School of Medicine

Haruka Fujimoto    -  Contact Me
Kyoto University, Graduate School of Medicine

Yasuyuki Fujimoto    -  Contact Me
Kyoto University, Graduate School of Medicine

Hiromasa Kira    -  Contact Me
Kyoto University, Graduate School of Medicine

Kazuhiro Takatoku    -  Contact Me
Kyoto University, Graduate School of Medicine

Kazuyoshi Kanno    -  Contact Me
Kyoto University, Graduate School of Medicine

Masahide Kawatou    -  Contact Me
Kyoto University, Graduate School of Medicine

Fumie Takai    -  Contact Me
Kyoto University, Graduate School of Medicine

Takahide Takeda    -  Contact Me
Kyoto University, Graduate School of Medicine

Takehiko Matsuo    -  Contact Me
Kyoto University, Graduate School of Medicine

Tadashi Ikeda    -  Contact Me
Kyoto University, Graduate School of Medicine

Hiroaki Osada    -  Contact Me
Kyoto University, Graduate School of Medicine

Objective
For thoracoabdominal aortic repair, we routinely employ straight incision with rib-cross (SIRC) incision to ensure good visual field and deep hypothermic circulatory arrest (DHCA) to prevent cerebral and spinal cord complications. In this study, we investigated risk factors associated with the perioperative strokes in these combined procedures.

Methods
We reviewed records of patients who underwent repair for thoracoabdominal aorta related disease between 2016 to 2023. Sixty patients underwent Crawford extent I or II aortic repair using SIRC and DHCA (39 men, 21 women; mean age, 63.5 ± 15.9 years; consisted of 11 aneurysm cases and 49 dissection cases, of which 14 cases were accompanied by arch lesions and required total or partial arch replacement via SIRC view or via median sternotomy). The patients were divided into two groups, those who experienced perioperative stroke (Stroke group) [with obvious image findings and persistent or temporary neurological deficits], and those who did not (Non-stroke group). Perioperative and postoperative data from patients' record were collected retrospectively and the variables were compared between the 2 groups.

Results
Eleven (18.3%) patients experienced stroke. Stroke group included 2 cases of hemiplegia, 4 cases of impaired consciousness (major strokes), 3 cases of seizure and 2 cases of obvious image findings without symptoms (minor strokes). Operative mortality were 2 cases in Stroke group and 4 cases in Non-stroke group (18.0% vs 8.2%, p=0.302). The age tended to be higher in Stroke-group (Stroke: 70.5 ± 9.0 years, Non-stroke: 62.0 ± 16.7 years, p=0.069). While 4 of Stroke-group patients had undergone arch reconstruction via SIRC view using selective cerebral perfusion which was significantly different (Stroke: 4 cases, 36.4%, Non-stroke: 2 case, 4.1%, p=0.008) patients who underwent arch reconstruction through a median sternotomy did not develop stroke. There were no significant differences in operation time, cardiopulmonary bypass time, circulatory arrest time, minimum body temperature, or blood transfusion volume between the two groups. In addition, there were no significant differences in length of ICU/hospital stay, or incidence of perioperative complications (acute renal failure, pneumonia, and spinal cord injury) between the two groups. Univariate analysis revealed that a significant risk factor for perioperative stroke following Crawford extent I or II aortic repair using SIRC and DHCA were the age (odds ratio = 1.05, 95% confidence interval: 0.99-1.12, p = 0.033) and arch reconstruction via SIRC view (13.4, 2.06-87.47, p = 0.005).

Conclusions
Although not statistically significant, the occurrence of stroke may worsen the short-term prognosis. Higher age and performing arch reconstruction via SIRC view were found to be associated with the occurrence of strokes. Even if the procedure is performed under SIRC and DHCA, care should be taken or furthermore adding median sternotomy should be considered when performing arch repair.

Descending/Thoracoabdominal Aorta