title: Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest: quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention.
abstract: OBJECTIVE
  The purpose of this study was to describe clinical outcome after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA), to determine mortality and length of stay, neurologic outcome, cardiorespiratory outcome, and hemostatic and renal outcome after DHCA.
  
  
  METHODS
  Retrospective and observational.
  
  
  METHODS
  Cardiothoracic operating rooms and intensive care unit (ICU).
  
  
  METHODS
  All adults requiring thoracic aortic repair with DHCA.
  
  
  METHODS
  None. The study was observational.
  
  
  RESULTS
  The cohort size was 110. All patients received an antifibrinolytic. The mortality rate was 8.2%. The mean length of stay was 6.8 days (ICU) and 14.0 days (hospital). The incidence of stroke was 8.1% and postoperative delirium was 10.9%. The rate of postoperative atrial fibrillation was 43.6%; 19.1% required postoperative mechanical ventilation longer than 72 hours. Chest tube drainage was 931 mL for the first 24 hours. Postoperative dialysis was required in 1.8% of patients. Renal dysfunction occurred in 40% to 50% of patients, depending on the definition.
  
  
  CONCLUSIONS
  The protocol for DHCA at the authors' institution is associated with superior or equivalent perioperative outcomes to those reported in the literature. This study identified the need for further quantification of the clinical outcomes after DHCA in order to prioritize outcome-based hypothesis-driven prospective intervention in DHCA.
authors.affiliation: Department of Anesthesia, Cardiothoracic Section, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com
authors.forename: John G
authors.initials: JG
authors.lastname: Augoustides
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Floyd
authors.forename: Michael L
authors.initials: ML
authors.lastname: McGarvey
authors.forename: E Andrew
authors.initials: EA
authors.lastname: Ochroch
authors.forename: Alberto
authors.initials: A
authors.lastname: Pochettino
authors.forename: Shelly
authors.initials: S
authors.lastname: Fulford
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Gambone
authors.forename: Justin
authors.initials: J
authors.lastname: Weiner
authors.forename: Sushma
authors.initials: S
authors.lastname: Raman
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Savino
authors.forename: Joseph E
authors.initials: JE
authors.lastname: Bavaria
authors.forename: David R
authors.initials: DR
authors.lastname: Jobes
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000601:surgery*; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D006801:Humans; D007036:Hypothermia, Induced; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures / Q000009:adverse effects*