Pressure-dependent band gap engineering with structural, electronic, mechanical, optical, and thermal properties of CsPbBr3: first-principles calculations.

CONTEXT: In the renewable industry, pressure-dependent CsPbBr3 perovskite has a lot of potential due to its exceptional properties. Present work revealed the mechanical stability of CsPbBr3 between 0 to 50 GPa. The bandgap of unstressed CsPbBr3 is 2.90 eV, indicating a direct bandgap. Band gap values decrease by increasing external pressure. CsPbBr3 structure showed a direct band gap from 0 to 35 GPa and in-direct from 40 to 50 GPa. The unit cell volume and lattice constants are substantially decreased. Mechanical parameters, i.e., Young's modulus, bulk modulus, anisotropy factor, shear modulus, and poison's ratio are obtained. Under ambient conditions, the mechanical properties of CsPbBr3 showed ductile behavior and with induced pressure, their ductility has significantly improved. By applying stresses ranging from 0 to 50 GPa, the considerable fluctuation in values of dielectric function (imaginary and real), absorption, reflectivity, loss function, refractive index (imaginary and real), and conductivity (imaginary and real), was also identified. When pressure rises, the optical parameters increase and drag in the direction of high energies. Response functions are used to predict the density of states and the phonon lattice dispersion to study the phonon properties. By using the quasi-harmonic Debye model, the thermal effect on the free energy, entropy, enthalpy, and heat capacity were predicted and compared. These results would be useful for theoretical research and indicate how external pressure significantly affects the physical characteristics of CsPbBr3 perovskites, which may open up new possibilities for use in optoelectronic, photonic, and solar cell applications. METHODS: The structural, electrical, mechanical, optical, and thermal properties of cesium lead bromide (CsPbBr3) are investigated by applying external pressure from 0 to 50 GPa, using generalized gradient approximations (GGA) and Perdew-Burke-Ernzerhof (PBE) with CASTEP code built-in material studio by density functional theory (DFT).

Acute type A intramural hematoma: The less-deadly acute aortic syndrome?

OBJECTIVE: To evaluate the short- and midterm outcomes of surgically managed acute type A intramural hematoma (IMH) versus classic acute type A aortic dissection (ATAAD). METHODS: From 1996 to February 2023, a total of 106 patients with acute type A IMH and 795 patients with classic ATAAD presented for open aortic repair at our institution. Data were obtained from the local Society of Thoracic Surgeons' Data Warehouse and medical chart review. RESULTS: Compared with the classic ATAAD group, the IMH group was older (65 vs 59 years, P < .001) and more likely to be female (45% vs 32%, P = .005), with fewer comorbidities such as severe aortic insufficiency (5.0% vs 25%, P < .001), acute stroke (2.8% vs 8.3%, P = .05), acute renal failure (5.7% vs 13%, P = .04), and malperfusion syndrome (8.5% vs 26%, P < .001) but more cardiac tamponade (18% vs 11%, P = .03). The IMH group had less aortic root replacement (15% vs 33%, P < .001), zone 2 arch replacements (9.4% vs 18%, P = .02), and shorter crossclamp times (120 minutes vs 150 minutes, P < .001). The operative mortality was significantly lower in the IMH group (0.9% vs 8.8%, P = .005) and a multivariable regression model showed IMH to be protective, odds ratio of 0.11, P = .03. The 10-year survival was similar between the 2 groups (65% vs 61%, P = .35). The hazard ratio of IMH for midterm mortality after surgery was 0.73, P = .12. CONCLUSIONS: Acute type A IMH could be treated with emergency open aortic repair with excellent short- and midterm outcomes.

Nonconventional Symmetric Double-Side Electrochromic Devices Employing a Nafion Conductive Layer to Unlock Superior Durability.

In this work, we present a methodology to create an effective novel double-sided symmetric architecture of solid-state electrochromic devices. This principally new nonconventional configuration provides access to novel electrochromic systems that could be applicable for the creation of smart double-side signage, smart boards, nonemissive displays, and other smart interactive devices that change their color upon application of a voltage. The proposed configuration is based on the assembly of two identical electrochromic materials facing each other through an opaque optical separator. As a proof of concept, we use an electrochromic material based on bis(4'-(pyridin-4-yl)-2,2':6',2″-terpyridine) iron complex, covalently immobilized on screen-printed surface-extended ITO support. The symmetric configuration allows for a drastic enhancement of the overall stability of the device due to both attenuation of the counter electrode polarization and minimization of electrolyte decomposition. A nontransparent ion-permeable separator, in turn, allows observing the color change of only one of the electrodes by cutting off the optical contribution of the electrode located behind it. Further functionalization of the electrochromic material with a thin layer of Nafion is a beneficial strategy to significantly boost up long-term durability of the devices. Applying a layer of Nafion to the electrochromic material results in an increase in ionic conductivity within the device and ensures better retention of electrochromic molecules on the surface, thus minimizing device decomposition during long-term electrochemical cycling. An electrochromic device that bears Nafion-functionalized electrodes can operate (i) in the dual-side mode, where both sides demonstrate effective electrochromic performance; or (ii) in a one-side manner, where only one side of the device changes color. Notably, when operating in the one-side mode, the device withstands 70,000 cycles, after which the performance of the device can be resumed by simply turning the device to the other side (via switching the polarity of the electrodes).

A La2O3/MXene composite electrode for supercapacitors with improved capacitance and cycling performance.

Developing efficient electrode materials is a key towards high power electrochemical energy storage devices. Two-dimensional (2D) MXene shows excellent conductivity and electrochemical performance among other materials. However, the restacking of MXene layers may degrade their specific capacity and cycling performance. Considering this challenge, here we have designed a composite made of 2D MXene nanosheets and lanthanum oxide (La2O3) nanoparticles to overcome the limitations. The bifunctionality of La2O3 nanoparticles prevents the restacking of MXene layers and enhances the electrochemical properties of the electrode due to its good Faradic characteristics. The specific capacitance of the La2O3/MXene composite electrode is 366 F/g at 1 A/g, which is 4.5 and 3 times higher than those of the individual La2O3 and MXene. The composite electrode displays a capacitance retention of 96% after 1,000 cycles, which is due to synergistic effects between the two components and indicates the potential of La2O3/MXene composite for supercapacitors.

Diagnosing the culprit behind a subtle case of concomitant right atrial myxoma and atrial fibrillation: A case report.

Myxomas are rare tumors arising from the uncontrolled proliferation of mesenchymal cells. Among cardiac conditions, cardiac myxomas account for less than 0.1% of cases, with the majority found in the left atrium and only 8% in the right atrium. Atrial myxomas present with various clinical manifestations, including constitutional symptoms, symptoms caused by blood flow obstruction, and tumor embolism. This case report describes a 50-year-old male patient presenting with syncope, fatigue, and dyspnea, who had a history of well-controlled hypertension and atrial fibrillation. Physical examination, further diagnostic workup, and echocardiography led to a provisional diagnosis of right atrial myxoma. The patient underwent a median sternotomy, and the tumor was surgically excised, resulting in both diagnostic and curative outcomes. Histological analysis confirmed the diagnosis of myxoma. This case report contributes valuable insights into the presentation, diagnostic challenges, and treatment of atrial myxoma.

Progression of distal aorta after endovascular fenestration/stenting in acute type A aortic dissection with malperfusion syndrome.

Objective: The study objective was to evaluate the progression of dissected distal aorta in patients with acute type A aortic dissection with malperfusion syndrome treated with endovascular fenestration/stenting and delayed open aortic repair. Methods: From 1996 to 2021, 927 patients presented with acute type A aortic dissection. Of these, 534 had DeBakey I dissection with no malperfusion syndrome and underwent emergency open aortic repair (no malperfusion syndrome group), whereas 97 patients with malperfusion syndrome underwent fenestration/stenting and delayed open aortic repair (malperfusion syndrome group). Sixty-three patients with malperfusion syndrome treated with fenestration/stenting were excluded due to no open aortic repair, including death from organ failure (n = 31), death from aortic rupture (n = 16), and discharged alive (n = 16). Results: Compared with the no malperfusion syndrome group, the malperfusion syndrome group had more patients with acute renal failure (60% vs 4.3%, P < .001). Both groups had similar aortic root and arch procedures. Postoperatively, the malperfusion syndrome group had similar operative mortality (5.2% vs 7.9%, P = .35) and permanent dialysis (4.7% vs 2.9%, P = .50), but more new-onset dialysis (22% vs 7.7%, P < .001) and prolonged ventilation (72% vs 49%, P < .001). The growth rate of the aortic arch (0.38 vs 0.35 mm/year, P = .81) was similar between the malperfusion syndrome and no malperfusion syndrome groups. The descending thoracic aorta growth rate (1.03 vs 0.68 mm/year, P = .001) and abdominal aorta growth rate (0.76 vs 0.59 mm/year, P = .02) were significantly higher in the malperfusion syndrome group. The cumulative incidence of reoperation over 10 years (18% vs 18%, P = .81) and 15-year survival outcome (50% vs 48%, P = .43) were similar between the malperfusion syndrome and no malperfusion syndrome groups. Conclusions: Endovascular fenestration/stenting followed by delayed open aortic repair was a valid approach for patients with malperfusion syndrome.

Effect Of Age, Gender And Type Of Varicosity On The Post-Operative Pain Score After Seven-Day Compression Dressing After Varicose Vein Surgery.

Great saphenous vein insufficiency is linked to 80% of all remarkable lower limb varicosities. A total of 30 patients were enrolled from OPD fulfilling the inclusion criteria after the approval of the hospital's ethical committee. Patients had compression dressing for seven days after surgery. The patients were divided into two groups-Group-A (Compression dressing for two days) and Group-B (Compression dressing for seven days). Stratification of pain score was done against age, gender, and grades of varicose veins, and after dividing into groups t- test was put into use. A p 20 value ≤0.05 was contemplated to be remarkable. Thirty patients with primary varicose vein were enrolled in this study. The mean age of patients was 35.4±9.9 years. Mean pain score in these patients was 2.9±0.8 years. Pain score after seven days of compression dressing after the surgery for varicose veins depend upon the gender, age, and grades of the varicosity of the veins. It is lesser in the females, younger age groups, and in those who had initially lesser severity of the varicose veins.

Massive left atrial myxoma leading to recurrent cerebrovascular accidents (CVAs) in a young woman: A case report.

Myxomas are tumors that occur due to uncontrolled proliferation of mesenchymal cells. Cardiac myxomas although very rare, are still the most common primary tumor of heart. Cardiac myxomas have a prevalence of 0.03% in the general population. They can have a variety of clinical presentations with obstructive cardiac symptoms, constitutional symptoms and symptoms due to embolism to other body parts chief among them. CNS embolism with stroke is among the rarest clinical presentation of cardiac myxomas. Our article portrays a case of cardiac myxomas that initially resulted in episodes of dyspnea and syncope and eventually led to recurrent episodes of transient ischemic attack and stroke. Case was confirmed by transesophageal echocardiography and managed surgically by medial sternotomy. Myxoma, a benign primary cardiac tumor is itself a rare occurrence, embolization of myxoma leading to multiple strokes is an atypical clinical presentation. Our report would be a valuable addition to the already existing literature.

Diphtheria: The rising cases of "Throat Distemper" in Pakistan: A short communication.

Background: The objective of this short communication is to summarize the current situation in Pakistan regarding the rising cases of diphtheria and to emphasize the need for public health interventions to control the spread of the disease. Study design: This study is a short communication. Methods: Data on diphtheria cases were collected from various sources including the Pakistan Ministry of Health, the World Health Organization (WHO), and media reports. Descriptive statistics were used to summarize the data on the number of cases and trends over time. Results: As of 2023, the number of reported diphtheria cases in Pakistan has increased by 50% compared to the previous year. The majority of cases are being reported from the Sindh and Punjab provinces. The incidence of diphtheria is highest among children under the age of 10. Conclusions: The rising cases of diphtheria in Pakistan are a cause for concern and indicate the need for effective public health interventions to control the spread of the disease. This includes increasing vaccine coverage, improving hygiene practices, and enhancing surveillance and reporting systems. The public health community should also work towards educating communities on the importance of vaccination and preventative measures to reduce the burden of diphtheria in Pakistan.

Situation-Aware BDI Reasoning to Detect Early Symptoms of Covid 19 Using Smartwatch.

Ambient intelligence plays a crucial role in healthcare situations. It provides a certain way to deal with emergencies to provide the essential resources such as nearest hospitals and emergency stations promptly to avoid deaths. Since the outbreak of Covid-19, several artificial intelligence techniques have been used. However, situation awareness is a key aspect to handling any pandemic situation. The situation-awareness approach gives patients a routine life where they are continuously monitored by caregivers through wearable sensors and alert the practitioners in case of any patient emergency. Therefore, in this paper, we propose a situation-aware mechanism to detect Covid-19 systems early and alert the user to be self-aware regarding the situation to take precautions if the situation seems unlikely to be normal. We provide Belief-Desire-Intention intelligent reasoning mechanism for the system to analyze the situation after acquiring the data from the wearable sensors and alert the user according to their environment. We use the case study for further demonstration of our proposed framework. We model the proposed system by temporal logic and map the system illustration into a simulation tool called NetLogo to determine the results of the proposed system.

Valve-Sparing Aortic Root Replacement Technique: Valsalva Graft versus Two Straight Tubular Grafts.

Background: There are many variations in valve-sparing aortic root replacement techniques. Our aim is to determine the impact of the graft on mid-term outcomes: Valsalva graft vs. two straight tubular grafts. Methods: From 2004 to 2020, 332 patients underwent valve-sparing aortic root replacement with either a Valsalva graft (Valsalva group: n = 270) or two straight tubular grafts (two-graft group: n = 62). Data were obtained through chart review and the National Death Index. Primary outcomes were mid-term survival and freedom from reoperation. Results: The preoperative characteristics of the groups were similar, but the two-graft group had more type A dissections (32% vs. 19%) and emergent operations (26% vs. 15%) and was younger (45 vs. 50 years). Intraoperatively, the groups were similar, but the two-graft group had longer cross-clamp (245 vs. 215 minutes) and cardiopulmonary bypass times (284 vs. 255 minutes). Postoperative complications including reoperation for bleeding, stroke, pacemaker implantation, and renal failure were slightly more frequent in the Valsalva group, but the differences were not significant. Operative mortality was similar between the Valsalva and two-graft groups (0.7% vs. 0%). Five-year survival in the two-graft group was 100% compared to 96% in the Valsalva group (p=0.56). Five-year freedom from reoperation in the two-graft group was 100% compared to 93% in the Valsalva group (p=0.29). Conclusions: The Valsalva and two-graft techniques both have excellent short- and mid-term outcomes. The two-graft technique might have slightly better survival and freedom from reoperation, but a larger sample size and longer follow-up are needed to determine if these advantages are significant.

Triticum aestivum: antioxidant gene profiling and morpho-physiological studies under salt stress.

BACKGROUND: Soil salinity drastically reduced wheat growth and production in Pakistan. It is a need of an hour to identify the best suitable salt tolerance or resistant wheat varieties which shows good growth under salinity affected areas. In presented study, two wheat varieties Johar (salt tolerant) and Sarsabaz (salt sensitive) were examined under NaCl stress conditions. METHODS: Antioxidant enzyme activities were investigated in 10-days old wheat seedlings under 200 mM NaCl stress in hydroponic conditions. To investigate the various growth parameters, antioxidant enzyme activities such as superoxide dismutase (SOD: EC 1.15.1.1), catalase (CAT: EC 1.11.1.6) and ascorbate peroxidase (APX: EC 1.11.1.11) were monitored and studied. Besides this various growth parameters such as length of the roots, shoots, as well as Physiological parameters likes lipid peroxidation by malondialdehyde (MDA), hydrogen peroxide (H2O2), and proline contents and antioxidant enzyme activities were estimated. The effect of salinity was also observed on gene transcription level and eventually expression level. RESULTS: Shoot and root length were decreased in Sarsabaz variety while it showed opposite trend in johar at 200 mM salt concentration. The concentration of proline showed a noticeable rise in salt dependency. Higher concentrations of Proline in Johar were observed as compared to Sarsabaz. SOD showed the increase in activity for antioxidant enzymes. Significant increase of SOD levels were observed in shoot tissues as compared to root tissues. The results indicated that the shoots were more susceptible to salt stress. Activity of APX showed similar affects in both varieties. The production of CAT enzyme in the shoot and root tissues of both varieties showed substantial growth under increased salt stress. Furthermore, NaCl stress has increased the expression of certain genes coding for antioxidant enzymes such as catalase, superoxide dismutase, and peroxidase. Maximum expression of all the antioxidant enzyme coding genes were observed in Johar (tolerant) at 48 h exposure to salt. In contrast the expression of the all mentioned genes in Sarsabaz variety were found maximum at early hours (24 h) and gradually decreased at 48 h. CONCLUSION: The study showed that the selected salt tolerant wheat variety Johar is significantly resistant to 200 mM NaCl salt level as compared to Sarsabaz.

Cross-cultural diversity analysis: traditional knowledge and uses of freshwater fish species by indigenous peoples of southern Punjab, Pakistan.

BACKGROUND: Fisheries have tremendous cultural and educational importance in human societies. The world is undergoing fast environmental and cultural changes, and local knowledge is being lost. Understanding how people interpret environmental change and develop practices in response to such change is essential to comprehend human resource use. This study was planned with the intent to document and conserve the knowledge about the uses of the freshwater fish fauna among the residents in South Punjab, Pakistan. METHODS: Semi-structured interviews and questionnaires were conducted to collect data from informers (N = 88). Principal component analysis, relative frequency citation, fidelity level, relative popularity level, rank-order priority, and similarity index were used to analyze the fish data. RESULTS: Overall, a total of 43 species of fishes were utilized in the study region, but only 26 species were utilized ethnomedicinally to treat a variety of illnesses such as asthma, body weakness, burn, chicken pox, cold, cough, eyesight, hepatitis, impotence, joint pain, night blindness, skin burn, spleen treatment, stomach infection, and weakness. The uses of fishes were analyzed employing various indices. The highest use value (UV) of 0.86 was calculated for spotted snakehead (Channa punctata), whereas the lowest UV of 0.05 was attained by karail fish (Securicula gora). Moreover, Channa punctata, Cyprinus carpio, Labeo rohita, Oreochromis niloticus, Wallago attu, Hypophthalmichthys molitrix, Rita rita, Sperata seenghala, Notopterus notopterus, Labeo dyocheilus, Systomus sarana, Puntius punjabensis, Securicula gora, Ompok bimaculatus, and Ompok pabda were the most popular species with RPL = 1.0. Out of the total, 20 species had a "zero" similarity index, while the ethnomedicinal use of 12 species (i.e., Labeo dyocheilus, Labeo boggut, Systomus sarana, Puntius punjabensis, Aspidoparia morar, Securicula gora, Crossocheilus diplochilus, Mastacembelus armatus, Ompok bimaculatus, Ompok pabda, Labeo gonius, and Sperata seenghala) was documented for the first time for a variety of diseases (i.e., body weakness, stomach infection, skin burn, joint pain, impotence, asthma, spleen treatment, and chicken pox). CONCLUSION: Our findings showed that the local people of the study area hold noteworthy traditional knowledge about the medicinal and cultural uses of fish species. Furthermore, a comprehensive analysis of active chemicals and in vivo and/or in vitro activities of chemicals derived from ichthyofauna with the highest FC as well as UVs could be interesting for research on new drugs.

Double cortex syndrome (subcortical band heterotopia): A case report.

Double cortex syndrome is an uncommon familial syndrome with X-linked dominant inheritance and most commonly presents with developmental delay and seizures. We present a case of a 14-year-old girl who came to neurology department of the hospital with severe generalized tonic-clonic fits and loss of consciousness. The mother of child gave history of uneventful antenatal period and labor. There was history of immediate cry and normal APGAR score. She was achieving milestones normally until at the age of 3 years when she suffered decline in her speech and vision. She had problems with learning with lack of concentration during her schooling. Physical examination was also unremarkable. Her lab values including complete blood count, serum calcium, and arterial blood gas tests, all were within normal limits. Electroencephalogram showed significant changes suggestive of epilepsy. Magnetic resonance imaging of brain showed continuous band of gray matter that was located deep and paralleling the cortex in both cerebral hemispheres suggestive of band heterotopia or double cortex syndrome. She was discharged and prescribed antiepileptics; and was advised regular outpatient follow-up.

An infant with Joubert syndrome: A case report.

Joubert syndrome is a rare neurological and developmental malfunction represented by decreased muscle tone, ataxia, and delayed developmental milestones. Joubert syndrome-related disorders, besides central nervous system, can involve other systems and thus can lead to multi-organ malfunction. We report a case of pure Joubert syndrome who presented with developmental delay, decreased muscle tone, and ataxia. Identification of molar tooth sign on magnetic resonance imaging studies assisted to make a definitive diagnosis. Detailed examination revealed no other significant findings of any organ of the body. Patient was managed conservatively with symptomatic treatment. Although these types of cases are rarely encountered, they can lead to multiple organ disabilities. Therefore, clinicians should always keep this diagnosis in mind whenever an infant presents with the aforementioned neurodevelopmental symptoms.

Distal Aortic Progression After Hemiarch, Zones 1-3 Arch Replacement in Acute Type A Aortic Dissection.

BACKGROUND: There is debate regarding aortic arch repair extent for acute type A aortic dissection (ATAAD) patients. METHODS: From 1996 to 2021, 756 ATAAD patients underwent open arch replacement. The cohort was divided into hemiarch (n = 481), zone 1 (n = 65), zone 2 (n = 148), and zone 3 (n = 62) arch replacement groups. Cross-group comparison of aortic growth was modeled using data from interval postoperative computed tomography or magnetic resonance imaging of the distal aorta. RESULTS: Demographics were not significantly different except the hemiarch group had more coronary artery disease and less stroke. Intraoperatively, zones 1, 2, and 3 had greater cardiopulmonary bypass, cross-clamp, and hypothermic circulatory arrest times and required more intraoperative blood transfusion than the hemiarch group. Perioperative outcomes were similar among groups except zone 3 had more reoperation for bleeding. Ten-year cumulative incidence of reoperation was hemiarch, 16.7%; zone 1, 16.3%; zone 2, 21.5%; and zone 3, 17.6% (P = .70). Ten-year survival was similar: hemiarch, 66%; zone 1, 60.3%; zone 2, 68.0%); and zone 3 66.1% (P = .20). Aortic arch, descending aorta, and abdominal aorta growth rates were not significantly different among groups over 10 years. In the whole cohort, the growth rate over time for aortic arch was 0.38 mm per year (P < .001), descending aorta 0.84 mm per year (P < .001), and abdominal aorta 0.69 mm per year (P < .001). CONCLUSIONS: There was no significant difference in long-term survival, distal aorta growth, or reoperation rate for distal aortic aneurysm after hemiarch or zones 1, 2, or 3 arch replacement. Patient-specific arch replacement strategies may be used rather than defaulting to aggressive arch replacement for all ATAAD patients.

Midterm outcomes of open repair versus endovascular descending thoracic aortic aneurysm repair.

Objective: The study objective was to evaluate the midterm outcome of thoracic endovascular aortic repair compared with open repair in patients with descending thoracic aortic aneurysm. Methods: From August 1993 to February 2023, 499 patients with descending thoracic aortic aneurysms underwent open repair (n = 221) or thoracic endovascular aortic repair (n = 278). Of these, 120 matched pairs were identified using propensity score matching based on age, sex, chronic lung disease, stroke, coronary artery disease, diabetes, ejection fraction, dialysis, peripheral vascular disease, prior cardiac surgery, connective tissue disease, and chronic dissection. Primary outcomes were postoperative paralysis, operative mortality, reoperation, and midterm survival. Results: After matching, the preoperative demographics and comorbidities were balanced in both groups. Intraoperatively, open repair had a lower temperature (18 °C vs 36 °C) and more patients required blood products (66% vs 8%), P < .001. Postoperatively, patients undergoing thoracic endovascular aortic repair had fewer strokes (2.5% vs 9.2%; P = .03), less dialysis (0% vs 3.3%; P = .04), and shorter length of stay (5 days vs 12 days, P < .001), but similar lower-extremity paralysis (2.5% vs 2.5%, P = 1.00) compared with open repair. Furthermore, thoracic endovascular aortic repair had higher 7-year incidence of first reoperation (16.1% vs 3.6%, P < .001) but similar operative mortality (0.8% vs 4.2%; P = .10) and 10-year survival outcome (56%; 95% CI, 43-72 vs 58%; 95% CI, 49-68; P = .55) compared with open aortic repair. The hazard ratio was 0.93 (P = .78) for thoracic endovascular aortic repair for midterm mortality and 6.87 (P < .001) for reoperation. Conclusions: Open repair could be the first option for patients with descending thoracic aortic aneurysms who were surgical candidates.

Hypothermic circulatory arrest versus aortic clamping in thoracic and thoracoabdominal aortic aneurysm repair.

BACKGROUND: To compare perioperative and midterm outcomes in thoracic and thoraco-abdominal aortic aneurysm (TAA and TAAA) repair using hypothermic circulatory arrest (HCA) or aortic clamping (AC) with mild hypothermia. METHODS: From 2012 to 2021 there were 180 open repairs of a TAA or TAAA, of which 90 (50%) were done with HCA and 90 (50%) with aortic clamping with mild hypothermia. The indications for HCA were arch aneurysm, TAA from chronic aortic dissection, and inability to clamp the aorta for proximal anastomosis. RESULTS: Compared to AC, the HCA group had less prior descending aorta replacement/repair (9.1% vs. 32%, p = 0.0001). Intraoperatively, the HCA group had more TAAs (70% vs. 20%, p < 0.0001) while the AC group had more TAAAs (80% vs. 30%, p < 0.0001). HCA group had longer cardiopulmonary bypass times (242 vs. 181 min, p < 0.0001) but shorter cross-clamp time (39 vs. 120 min, p < 0.0001) and lower temperatures (18°C vs. 34°C, p < 0.0001). Postoperatively, the HCA group had longer intubation times (31 vs. 26 h, p = 0.002), but all other postoperative outcomes including paralysis (2.2% vs. 8.9%, p = 0.08), and operative mortality (4.4% vs. 2.2%, p = 0.68) were similar between HCA and AC groups. Patient age was an independent risk factor for postoperative paralysis (OR 1.07, p = 0.03) while HCA was not significant (OR 0.37, p = 0.21). Five-year survival was similar between HCA and AC groups (85% vs. 80%, p = 0.36). CONCLUSIONS: Postoperative outcomes and midterm survival were acceptable in thoracic and thoracoabdominal aneurysm patients after HCA or AC. Both HCA and AC with mild hypothermia were valid approaches in TAA/A repair.