Impact of Antegrade Cerebral Perfusion Time on Outcomes of Aortic Arch Surgery

P0152 

Abstract Submission 

Yu Hohri (1), Megan Chung (1), Giacomo Murana (2), Yanling Zhao (1), Sabrina Castagnini (2), Edoardo Bianco (2), Paul Kurlansky, MD (1), Davide Pacini (2), Hiroo Takayama (1)

(1) NewYork- Presbyterian/Columbia University Medical Center, New York, NY, (2) S.Orsola Hospital, Bologna, Italy

Yu Hohri    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

Megan Chung    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

Giacomo Murana    -  Contact Me
S.Orsola Hospital

Yanling Zhao    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

Sabrina Castagnini    -  Contact Me
S.Orsola Hospital

Edoardo Bianco    -  Contact Me
S.Orsola Hospital

*Paul Kurlansky, MD    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

*Davide Pacini    -  Contact Me
S.Orsola Hospital

*Hiroo Takayama    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

Yu Hohri    -  Contact Me
N/A

Objective
Bilateral selective antegrade cerebral perfusion (ACP) has been proven safe in aortic arch surgery. However, there is a paucity of literature on the relationship between ACP time and in-hospital outcomes. The aim of this study is to evaluate the association between ACP time and major postoperative outcomes of patients who have undergone arch surgery with bilateral selective ACP.
Methods
This is a multi-center retrospective study of patients who underwent arch surgery with bilateral SACP and deep or moderate HCA (21.1-28.0°C) between 2005 and 2021. Logistic analysis was performed to determine the relationship of SACP time on the major postoperative outcomes of in-hospital mortality, stroke, renal failure, and prolonged ventilation. SACP time was used as a continuous and categorical variable. It was categorized into four groups at 30-minute intervals (SACP<30min (n=191), 31min<SACP<60min (n=303), 61<SACP<90min (n=263), SACP>91min (n=233)). Cubic spline interpolation was used to estimate the relationship between SACP time and the adjusted odds ratio of these complications.
Results
Among a total of 990 patients, 410 (41.4%) underwent hemiarch and 580 (58.6%) underwent total arch replacement with bilateral SACP and MHCA. The median (IQR) age was 65.5 (56.0-72.0) and the surgical indication was acute aortic dissection in 407 patients (41.1%). The median SACP time was 61.0 (35.0-89.0) min, the median cardiopulmonary bypass (CPB) time was 200.0 (166.0-244.0) min, and the median lower body ischemia (LBI) time was 43.0 (33.0-54.0) min. By cubic spline curve, the adjusted odds ratio of renal failure and prolonged intubation increased as SACP time increased; in contrast, in-hospital mortality and stroke did not increase (Figure 1). As a continuous variable, SACP time was not associated with any major outcome in multivariate analysis (mortality, OR=0.996 [0.99–1.003], p=0.28; stroke, OR=0.99 [0.98-1.00], p=0.06; renal failure, OR=1.00 [0.99-1.01], p=0.92; prolonged ventilation, OR=0.999 [0.99-1.004], p=0.78). Increased CPB time was associated with in-hospital mortality and prolonged ventilation (mortality, OR=1.01 [1.00–1.01], p<0.01; prolonged intubation, OR=1.01 [1.005-1.01], p<0.001), as was LBI time for renal failure (OR=1.01 [1.00–1.02], p=0.04). As a categorial variable, SACP time, even over 90 minutes, was not associated with any major outcomes (mortality, OR=1.25 [0.40–3.88], p=0.70; stroke, OR=0.26 [0.07-0.91], p=0.03; renal failure, OR=1.19 [0.47-3.04], p=0.72; prolonged ventilation, OR=1.22 [0.39-3.78], p=0.73).
Conclusion
In aortic arch surgery with ACP, ACP time, even with extended duration, was not associated with major in-hospital complications. ACP time may not be a suitable variable to address surgical impact of arch surgery.

Aortic Arch