Improvement of quality of life after surgery on the thoracic aorta: effect of antegrade cerebral perfusion and short duration of deep hypothermic circulatory arrest.
BACKGROUND
We have recently demonstrated that the use of deep hypothermic circulatory arrest (DHCA) during surgery for acute type A aortic dissections or thoracic aortic aneurysms adversely affect mid-term quality of life (QoL). The aim of this study is to assess the impact of DHCA duration and the potential effects of antegrade cerebral perfusion (ACP) on mid-term QoL.


RESULTS
Between January 1994 and December 2002, 363 patients underwent surgery of the thoracic aorta with the use of DHCA at our institution. One hundred seventy-six (48.5%) presented with acute type A dissections and 187 (51.5%) presented with aortic aneurysms. ACP was used in 41 (11.3%) cases. All in-hospital data were assessed and a follow-up was performed in all survivors after 2.4+/-1.2 years. QoL was analyzed with the Short-Form 36 Health Survey Questionnaire (SF-36). In-hospital mortality was 8.6%. In comparison with patients having undergone DHCA <20 minutes, averaged QoL score was significantly decreased in patients with DHCA between 20 and 34 minutes (95.6+/-12.8 versus 81.9+/-15.7; P<0.01) and >35 minutes (61.8+/-18.3; P<0.01). Averaged QoL score was significantly better with the use of ACP, independently of the duration of DHCA.


CONCLUSIONS
DHCA duration >20 minutes, and especially >35 minutes, adversely affects mid-term QoL in patients undergoing surgery of the thoracic aorta. The use of ACP, however, improved averaged QoL score at each time period and allows DHCA to be extended up to 30 minutes, without impairment in mid-term QoL.
Immer
Franz F
FF
Department of Cardiovascular Surgery, University Hospital, 3010 Berne, Switzerland. franzimmer@yahoo.de
Lippeck
Christiane
C
Barmettler
Hanna
H
Berdat
Pascal A
PA
Eckstein
Friedrich S
FS
Kipfer
Beat
B
Saner
Hugo
H
Schmidli
Jürg
J
Carrel
Thierry P
TP
D000203:Activities of Daily Living; D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006801:Humans; D007036:Hypothermia, Induced; D002534:Hypoxia, Brain / Q000517:prevention & control; D007431:Intraoperative Complications / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000517:prevention & control; D011184:Postoperative Period; D011788:Quality of Life; D012380:Role; D011795:Surveys and Questionnaires; D013997:Time Factors