Aortic root surgery in combination with hypothermic circulatory arrest: preserve or replace the aortic valve in the context of postoperative neurological outcome? A case match comparison.
The objective of this study was to compare the results of elective composite (C) vs. David (D) operations in patients requiring additional aortic arch surgery using hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SACP), with the focus on postoperative neurological outcome and quality of life (SF-36). Between November 1999 and March 2006, 333 patients underwent aortic root surgery and ascending aortic replacement with HCA and SACP at our institution. Out of these patients, 46 were matched with respect to age, gender, HCA-time and year of surgery. Two patients, one in each group, died during hospital stay (4%), with no late deaths. Follow-up was completed in 95% [64 (6-90) months]. Cardiopulmonary bypass (CPB) time (141 min vs. 168 min, P=0.007) and aortic cross-clamp time (99 min vs. 123 min, P=0.004) were significantly longer in the David-group. The incidence of temporary neurological dysfunction (TND 7%: D n=1, C n=2) was not different between groups, no permanent dysfunction could be detected. Follow-up SF-36 scores were comparable. The combination of aortic arch surgery with more time consuming valve sparing aortic root surgery does not increase the risk for adverse outcome applying comparable periods of HCA and SACP.
Department of Cardiac, Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, 30625 Hannover, Germany. Khaladj.Nawid@mh-hannover.de
Nawid
N
Khaladj
Issam
I
Ismail
Malakh
M
Shrestha
Sven
S
Peterss
Maximilian
M
Pichlmaier
Klaus
K
Kallenbach
Axel
A
Haverich
Christian
C
Hagl
D000368:Aged; D001018:Aortic Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D002315:Cardiopulmonary Bypass; D016022:Case-Control Studies; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects* / Q000401:mortality; D003250:Constriction; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D018579:Patient Selection; D010477:Perfusion; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome