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.
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.
Augoustides
John G
JG
Department of Anesthesia, Cardiothoracic Section, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283, USA. yiandoc@hotmail.com
Floyd
Thomas F
TF
McGarvey
Michael L
ML
Ochroch
E Andrew
EA
Pochettino
Alberto
A
Fulford
Shelly
S
Gambone
Andrew J
AJ
Weiner
Justin
J
Raman
Sushma
S
Savino
Joseph S
JS
Bavaria
Joseph E
JE
Jobes
David R
DR
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*