Prior Circulatory Arrest Is Not a Risk Factor for Stroke or Other Adverse Outcomes in Total Arch Replacement
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0267
Submission Type:
Abstract Submission
Authors:
Adam Carroll (1), Nicolas Chanes (1), Michael Kirsch (1), Ananya Shah (1), Muhammad Aftab (1), T. Brett Reece (1)
Institutions:
(1) University of Colorado Anschutz, Denver, CO
Submitting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Co-Author(s):
Nicolas Chanes
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University of Colorado Anschutz
University of Colorado Anschutz
Michael Kirsch
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University of Colorado Anschutz
University of Colorado Anschutz
Ananya Shah
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University of Colorado Anschutz
University of Colorado Anschutz
*Muhammad Aftab
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University of Colorado Anschutz
University of Colorado Anschutz
*T. Brett Reece
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University of Colorado Anschutz
University of Colorado Anschutz
Presenting Author:
Adam Carroll
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University of Colorado Anschutz
University of Colorado Anschutz
Abstract:
Objective
With improvements in management of aortic pathology, including type A dissection, patients are more likely to survive their index pathology and over time have degeneration of their arch that necessitates a re-do arch replacement. It remains unclear if prior arch surgery confers additional risk of neurologic or other adverse outcomes in patients undergoing total arch replacement. We sought to evaluate if prior arch surgery requiring circulatory arrest increased the risk of stroke, or other morbidity and mortality in patients undergoing elective total arch replacement.
Methods
Using our prospectively maintained retrospective institutional aortic database, we identified patients who were undergoing elective total arch replacement. The patients were stratified into two cohorts: those who had a previous arch replacement requiring circulatory arrest, and those who did not.
Results
In total, 113 patients were identified from 2011-2023 who underwent elective total arch replacement. Of these, 44 had no prior procedure requiring circulatory arrest, and 69 had a prior arch replacement requiring circulatory arrest. Regarding demographic characteristics, the only variable of significance was younger age (p=0.014) in repeat circulatory arrest patients. Cardiopulmonary bypass times (p=0.001), and intraoperative administration of FFP (p=0.023) and platelets (p=0.005) were higher in repeat circulatory arrest patients, with a trend towards increased circulatory arrest times (p=0.058). No differences were found in length of stay, ICU length of stay, or post-operative morbidity or mortality between the two cohorts.
Conclusion
Although there were increases in cardiopulmonary bypass time and in intra-operative administration of coagulation products, likely related to scar tissue from prior aortic surgery, there was no significant difference between the two cohorts in post-operative outcomes. Patients undergoing total arch replacement should be counseled that prior aortic arch surgery does not increase their risk of stroke or other adverse outcomes.
With improvements in management of aortic pathology, including type A dissection, patients are more likely to survive their index pathology and over time have degeneration of their arch that necessitates a re-do arch replacement. It remains unclear if prior arch surgery confers additional risk of neurologic or other adverse outcomes in patients undergoing total arch replacement. We sought to evaluate if prior arch surgery requiring circulatory arrest increased the risk of stroke, or other morbidity and mortality in patients undergoing elective total arch replacement.
Methods
Using our prospectively maintained retrospective institutional aortic database, we identified patients who were undergoing elective total arch replacement. The patients were stratified into two cohorts: those who had a previous arch replacement requiring circulatory arrest, and those who did not.
Results
In total, 113 patients were identified from 2011-2023 who underwent elective total arch replacement. Of these, 44 had no prior procedure requiring circulatory arrest, and 69 had a prior arch replacement requiring circulatory arrest. Regarding demographic characteristics, the only variable of significance was younger age (p=0.014) in repeat circulatory arrest patients. Cardiopulmonary bypass times (p=0.001), and intraoperative administration of FFP (p=0.023) and platelets (p=0.005) were higher in repeat circulatory arrest patients, with a trend towards increased circulatory arrest times (p=0.058). No differences were found in length of stay, ICU length of stay, or post-operative morbidity or mortality between the two cohorts.
Conclusion
Although there were increases in cardiopulmonary bypass time and in intra-operative administration of coagulation products, likely related to scar tissue from prior aortic surgery, there was no significant difference between the two cohorts in post-operative outcomes. Patients undergoing total arch replacement should be counseled that prior aortic arch surgery does not increase their risk of stroke or other adverse outcomes.
Aortic Symposium:
Cerebral Protection
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