title: Outcomes after thoracoabdominal aortic aneurysm repair using hypothermic circulatory arrest.
abstract: OBJECTIVE
  To evaluate our experience with thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass and hypothermic circulatory arrest.
  
  
  METHODS
  A total of 243 patients underwent thoracoabdominal aortic aneurysm repair with full cardiopulmonary bypass and hypothermic circulatory arrest. The degree of repair was Crawford extent I in 63 (26%), Crawford extent II in 97 (40%), and Crawford extent III in 83 patients (34%). Degenerative aneurysms were the most frequent indication for surgery, and 18 patients (7.4%) required emergency surgery.
  
  
  RESULTS
  The mean duration of cardiopulmonary bypass and hypothermic circulatory arrest was 160 ± 44 and 31 ± 12 minutes, respectively. Stroke occurred in 9 patients (3.7%) and spinal cord ischemic injury in 13 patients (5.3%; 9 with paraplegia and 4 with paraparesis). Temporary dialysis for new-onset renal failure was required in 3.6% of hospital survivors. The 30-day mortality rate was 7.8% (13 patients). It was 33.3% after emergency surgery and 5.6% after elective surgery (P = .001). Spinal cord ischemic injury occurred more frequently after emergency than after elective surgery (16.7% vs 3.9%; P = .04). The overall 5-year survival was 55% and was significantly better for patients with nondegenerative aortic disease.
  
  
  CONCLUSIONS
  Cardiopulmonary bypass with hypothermic circulatory arrest can be safely used for thoracoabdominal aortic aneurysm repair, providing excellent protection against end-organ injury. The early and late mortality rates did not exceed those reported for other open techniques or for endovascular repair, with particularly favorable outcomes among patients undergoing elective repair.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Missouri Baptist Medical Center, St Louis, Mo 63131, USA. ntkouch@aol.com
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.forename: Alexander
authors.initials: A
authors.lastname: Kulik
authors.forename: Catherine F
authors.initials: CF
authors.lastname: Castner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D002315:Cardiopulmonary Bypass; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000401:mortality; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology; D010264:Paraplegia / Q000209:etiology; D006435:Renal Dialysis; D051437:Renal Insufficiency / Q000209:etiology / Q000628:therapy; D012307:Risk Factors; D020760:Spinal Cord Ischemia / Q000209:etiology; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult