Predictors of outcomes after correction of acute type a aortic dissection under moderate hypothermic circulatory arrest and antegrade cerebral perfusion
Rev. bras. cir. cardiovasc
;
33(2): 143-150, Mar.-Apr. 2018. tab
Article
Dans Anglais
| 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.
Texte intégral:
Disponible
Indice:
LILAS (Amériques)
Sujet Principal:
Anévrysme de l'aorte
/
Encéphale
/
Pontage cardiopulmonaire
/
Reperfusion
/
Arrêt circulatoire en hypothermie profonde
/
Type d'étude:
Etude d'étiologie
/
Étude observationnelle
/
Étude pronostique
/
Facteurs de risque
Limites du sujet:
Adulte très âgé
/
Femelle
/
Humains
/
Mâle
langue:
Anglais
Texte intégral:
Rev. bras. cir. cardiovasc
Thème du journal:
Cardiologie
/
Chirurgie générale
Année:
2018
Type:
Article
Pays d'affiliation:
Grèce
Institution/Pays d'affiliation:
Onassis Cardiac Surgery Center/GR
/
University of Athens/GR
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