title: Recent thoraco-abdominal aortic repair outcomes using moderate-to-deep hypothermia combined with targeted reconstruction of the Adamkiewicz artery†.
abstract: OBJECTIVE
  We retrospectively reviewed the surgical results of thoraco-abdominal aortic repair using moderate-to-deep hypothermia combined with targeted reconstruction of the Adamkiewicz artery (AKA).
  
  
  METHODS
  Between 2006 and 2014, 100 patients underwent thoraco-abdominal aortic aneurysm repair using moderate-to-deep hypothermia. Their mean age was 58 ± 15 years and 76 (76%) were men. Their aortic pathologies included acute dissection (5), chronic dissection (74), degeneration (20) and infection (1). Thirty-four had connective tissue disorders and 5 had emergency operations. The degrees of repair were Crawford extent I for 11, II for 76 and III for 13. Seven had concomitant arch repair. Preoperative magnetic resonance angiography or computed tomographic angiography was performed to detect the AKA in 95. We used deep hypothermia (18 °C) for those requiring open proximal aortic anastomosis for cerebral protection and moderate hypothermia (25 °C) for those not requiring open proximal aortic anastomosis.
  
  
  RESULTS
  Two patients had spinal cord injuries and 4 had a stroke. For those in whom the AKA was identified (90%), all had targeted artery reconstruction. The mean pairs of reconstructed intercostal arteries were 1.5 ± 0.7. There were 5 in-hospital deaths for which the causes were lung bleeding (2), infection (2) and iliac aneurysm rupture (1). Temporary dialysis for new-onset renal failure was required for 9. The mean postoperative mechanical ventilation period was 1.7 ± 1.9 days. Six required a tracheostomy due to respiratory failure.
  
  
  CONCLUSIONS
  Moderate-to-deep hypothermia combined with targeted reconstruction of the AKA provided satisfactory outcomes with thoraco-abdominal aortic repair, particularly for spinal cord protection.
authors: National Cerebral and Cardiovascular Center, Suita, Japan hirtanak@hsp.ncvc.go.jp.
authors: Hiroshi
authors: H
authors: Tanaka
authors: National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Kenji
authors: K
authors: Minatoya
authors: National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Hiroaki
authors: H
authors: Sasaki
authors: National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Yoshimasa
authors: Y
authors: Seike
authors: National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Tatsuya
authors: T
authors: Itonaga
authors: National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Tatsuya
authors: T
authors: Oda
authors: National Cerebral and Cardiovascular Center, Suita, Japan.
authors: Junjiro
authors: J
authors: Kobayashi
mesh_terms: D000368:Aged; D000792:Angiography / Q000379:methods; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007902:Length of Stay; D018810:Magnetic Resonance Angiography / Q000379:methods; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D056888:Patient Positioning; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D019651:Plastic Surgery Procedures / Q000379:methods / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000098:blood supply; D013119:Spinal Cord Injuries / Q000209:etiology / Q000517:prevention & control; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality
keywords: Hypothermia; Spinal cord protection; Thoraco-abdominal aorta