Hypothermic cardiopulmonary bypass and circulatory arrest in the management of extensive thoracic and thoracoabdominal aortic aneurysms.
Hypothermic cardiopulmonary bypass, usually in combination with an interval of circulatory arrest, was used for the treatment of 211 patients with extensive thoracic or thoracoabdominal aortic disease during a 17-year interval. Profound hypothermia, distal perfusion, and intravenous methylprednisolone and thiopental were used for neuroprotection. No other technique or other adjunctive agents were used. The 30-day mortality rate was 7.1% (15 patients). It was 40% (8 of 20) for patients undergoing emergent operations for aortic rupture or acute dissection and 3.7% (7 of 191) for all other patients (P<0.001). Paraplegia occurred in 5 and paraparesis in 1 of the 205 operative survivors whose lower limb function could be assessed postoperatively (2.9%). Of the 121 survivors with thoracoabdominal aortic disease, paraplegia occurred in 1 of 38 patients with Crawford type I disease (2.6%), 2 of 49 with type II (4.1%), and 2 of 34 with type III (5.9%). Paralysis developed in 1 (1.7%) of the 58 patients who underwent aortic dissection. Renal dialysis was required in 6 (2.9%) of the 205 operative survivors, prolonged inotropic support (>48 hours) in 23 (11%), reoperation for bleeding in 10 (5%), mechanical ventilation (>48 hours) in 50 (24%), and tracheostomy in 21 (10%). Four (1.9%) patients sustained a stroke. Hypothermic cardiopulmonary bypass provides safe and substantial protection against paralysis, and renal, cardiac, and visceral organ system failure that equals or exceeds that of other currently used techniques but without the need for other adjuncts.
Kouchoukos
Nicholas T
NT
Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St. Louis, MO 63131, USA. NTKouch@aol.com
Masetti
Paolo
P
Murphy
Suzan F
SF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000628:therapy; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000628:therapy*; D001019:Aortic Rupture / Q000401:mortality / Q000628:therapy; D001243:Assisted Circulation; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D020760:Spinal Cord Ischemia / Q000209:etiology; D013223:Statistics as Topic; D016019:Survival Analysis; D016896:Treatment Outcome