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Predictors of outcomes after correction of acute type a aortic dissection under moderate hypothermic circulatory arrest and antegrade cerebral perfusion
Samanidis, George; Katselis, Charalampos; Contrafouris, Constantinos; Georgiopoulos, Georgios; Kriaras, Ioannis; Antoniou, Theofani; Perreas, Konstantinos.
  • Samanidis, George; Onassis Cardiac Surgery Center. First Department of Adult Cardiac Surgery. Athens. GR
  • Katselis, Charalampos; Onassis Cardiac Surgery Center. First Department of Adult Cardiac Surgery. Athens. GR
  • Contrafouris, Constantinos; Onassis Cardiac Surgery Center. First Department of Adult Cardiac Surgery. Athens. GR
  • Georgiopoulos, Georgios; University of Athens. Hippokration Hospital. First Department of Cardiology. Athens. GR
  • Kriaras, Ioannis; Onassis Cardiac Surgery Center. Department of Cardiac Surgery Intensive Care Unit. Athens. GR
  • Antoniou, Theofani; Onassis Cardiac Surgery Center. Department of Anesthesiology. Athens. GR
  • Perreas, Konstantinos; Onassis Cardiac Surgery Center. First Department of Adult Cardiac Surgery. Athens. GR
Rev. bras. cir. cardiovasc ; 33(2): 143-150, Mar.-Apr. 2018. tab
Article in English | LILACS | ID: biblio-958392
ABSTRACT
Abstract

Introduction:

Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest.

Methods:

Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion.

Results:

Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were preoperative hemodynamic instability (OR 14.8, 95% CI 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR 5.0, 95% CI 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR 8.8, 95% CI 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR 13.6, 95% CI 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR 15.9, 95% CI 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%.

Conclusion:

Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Aortic Aneurysm / Brain / Cardiopulmonary Bypass / Reperfusion / Circulatory Arrest, Deep Hypothermia Induced / Aortic Dissection Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male Language: English Journal: Rev. bras. cir. cardiovasc Journal subject: Cardiology / General Surgery Year: 2018 Type: Article Affiliation country: Greece Institution/Affiliation country: Onassis Cardiac Surgery Center/GR / University of Athens/GR

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Full text: Available Index: LILACS (Americas) Main subject: Aortic Aneurysm / Brain / Cardiopulmonary Bypass / Reperfusion / Circulatory Arrest, Deep Hypothermia Induced / Aortic Dissection Type of study: Etiology study / Observational study / Prognostic study / Risk factors Limits: Aged / Female / Humans / Male Language: English Journal: Rev. bras. cir. cardiovasc Journal subject: Cardiology / General Surgery Year: 2018 Type: Article Affiliation country: Greece Institution/Affiliation country: Onassis Cardiac Surgery Center/GR / University of Athens/GR