title: Reoperation of the proximal aorta: impact of presternotomy extracorporeal circulation on clinical outcomes.
abstract: OBJECTIVE
  Adverse events can occur during a sternotomy for reoperation of the proximal aorta. Presternotomy extracorporeal circulation is often employed to avoid catastrophic events. The purpose of this study was to investigate the impact of presternotomy extracorporeal circulation on clinical outcomes of redo proximal aortic surgery.
  
  
  METHODS
  Between January 1990 and December 2005 a total of 21 aneurysms or dissections of the proximal aorta were repaired via a repeat sternotomy. Extracorporeal circulation was established before the sternotomy in 9 (49%) patients and after the sternotomy in 12 (51%) patients.
  
  
  RESULTS
  There were no statistically significant differences in the age, sex, emergency surgery, chronic obstructive pulmonary disease, and renal function between the groups. Femoral cannulation was used more often in the presternotomy extracorporeal circulation group (8/9, 89% vs. 1/12, 8.3%; P = 0.000). The difference in the pump time did not reach a statistically significant level. The 30-day and in-hospital mortality rates were 11% (1/9) and 11% (1/9) in the presternotomy extracorporeal circulation group and 0% (0/12) and 17% (2/12) in the poststernotomy extracorporeal circulation group. There were no statistically significant differences in stroke, respiratory failure, myocardial infarction, or renal failure. There was a trend toward a longer hospital stay in the presternotomy extracorporeal circulation group (85.8 vs. 48.1 days; P = 0.06).
  
  
  CONCLUSIONS
  Presternotomy extracorporeal circulation was not associated with any major adverse outcomes such as death, stroke, or renal failure.
authors.affiliation: Department of Cardiovascular Surgery, Social Insurance Chukyo Hospital, 1-1-10 Sanjyo, Minami-ku, Nagoya, 457-8510, Japan. tomonobu_abe@chukyo-hosp.jp
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Abe
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.forename: Masaharu
authors.initials: M
authors.lastname: Yoshikawa
authors.forename: Hideki
authors.initials: H
authors.lastname: Oshima
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Akita
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D002318:Cardiovascular Diseases / Q000209:etiology; D005112:Extracorporeal Circulation / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality