P267. Prior Circulatory Arrest Is Not a Risk Factor for Stroke or Other Adverse Outcomes in Total Arch Replacement
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
University of Colorado Anschutz
Denver, CO
United States - Contact Me
Adam Carroll is a current PGY-3 surgical resident at the University of Colorado. Adam attended medical school at the University of Colorado and has been involved in research with the cardiothoracic surgery department throughout medical school and residency. He has interest specifically in endovascular and transcatheter aortic interventions, as well as neurologic outcomes in aortic research. He is currently in the aortic surgery research labaratory in the Department of Cardiothoracic Surgery at the University of Colorado. He plans to pursue a career in cardiothoracic surgery following his general surgery residency.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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.
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
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.
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
Presentation Duration
PODS will be on display in the exhibit hall for the duration of the meeting during exhibit hall hours. PODS will also be available for viewing on the meeting website. There is no formal presentation associated with your POD, but we encourage you to visit the PODS area during breaks to connect with those viewing.