Risks and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-center, Retrospective Cohort Study

Abstract BackgroundImpairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its risks and associations with outcomes. The objective of this study was to analyze the risks of impaired CA, based on cerebral oximetry index (COx), in patients undergoing total aortic arch replacement with CPB and moderate hypothermic circulatory arrest (MHCA). We also evaluated the association between impaired CA and patient outcomes.MethodsOne hundred fifteen four adult patients who underwent total aortic arch replacement with stented elephant trunk implantation under CPB and MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if post-CPB COx > 0.3, calculated based on a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO2) and mean blood pressure (MAP). Pre- and intraoperative factors were tested for independent association with impaired CA. Postoperative outcomes were compared between patients with normal and impaired CA.ResultsIn our 154 patients, 46(29.9%) developed new-onset impaired CA after CPB with MHCA. Multivariate analysis revealed a prolonged low rScO2 (rScO2 <55%) independently associated with onset of impaired CA, and receiver operating charactoristic curve showed a cutoff value at 40 min (sensitivity, 89.5%; specificity, 68.0%). Compared with normal CA patients, those with impaired CA showed a significantly higher rates of in-hospital mortality and postoperative complications.ConclusionProlonged low rScO2 (rScO2 <55%) during aortic arch surgery was closely related to onset of impaired CA. Impaired CA remained associated with the increased rates of postoperative complications and in-hospital mortality.Trial registration: ChiCTR1800014545 with registered date 20/01/2018.

Download Full-text

The Occurrence and Association of Impaired Cerebral Autoregulation With Outcomes in Aortic Arch Surgery: A Single-Center, Retrospective Study

10.21203/rs.3.rs-712359/v1 ◽

2021 ◽

Author(s):

Ling Peng ◽

Wei Wei ◽

Jun Zeng ◽

Jiapei Yang ◽

Rurong Wang

Keyword(s):

Postoperative Complications ◽

Hospital Mortality ◽

Aortic Arch ◽

Cerebral Autoregulation ◽

Circulatory Arrest ◽

Cerebral Oximetry ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

New Onset

Abstract Backgroundː Impairment of cerebral autoregulation (CA) has been observed in patients undergoing cardiopulmonary bypass (CPB), but little is known about its occurrence and associations with outcomes. The objective of this study was to analyze the occurrence of impaired CA, based on cerebral oximetry index (COx), in patients undergoing total aortic arch replacement with CPB and moderate hypothermic circulatory arrest (MHCA). We also evaluated the association between impaired CA and patient outcomes.Methodsː Sixty-four patients who underwent total aortic arch replacement with stented elephant trunk implantation under CPB and MHCA at our hospital were retrospectively analyzed. Patients were defined as having new-onset impaired CA if post-CPB COx > 0.3, calculated based on a moving linear correlation coefficient between regional cerebral oxygen saturation (rScO2) and mean blood pressure (MAP). Postoperative complication and in-hospital mortality were compared between patients with normal and impaired CA.Resultsː Of the 64 patients, 19(29.7%) developed new-onset impaired CA after CPB with MHCA. Compared with normal CA patients, those with impaired CA showed a significantly longer duration of rScO2 <55%, and significantly higher rates of in-hospital mortality and postoperative complications (acute kidney injury, delirium, mechanical ventilation > 24h, and respiratory infection). Conclusionsː In our cohort, 29.7% of patients who underwent total aortic arch replacement developed new-onset impaired CA after CPB with MHCA. Impaired CA might be associated with significantly increased rates of postoperative complications and in-hospital mortality. Clinical trial registration: ChiCTR1800014545 with registered date 20/01/2018.

Download Full-text

Risk Factor Analysis of Clinical Outcomes of Total Aortic Arch Replacement and Frozen Elephant Trunk With Aortic Balloon Occlusion

10.21203/rs.3.rs-554555/v1 ◽

2021 ◽

Author(s):

Luchen Wang ◽

Yunfeng Li ◽

Yaojun Dun ◽

Xiaogang Sun

Keyword(s):

Hospital Stay ◽

Aortic Arch ◽

Circulatory Arrest ◽

Balloon Occlusion ◽

Conventional Group ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Aortic Balloon Occlusion

Abstract Background: Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 minutes, which increases the surgical risk. We invented an aortic balloon occlusion technique that requires 5 minutes of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods: This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of aortic balloon occlusion group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during the in-hospital stay were also recorded. Results: The 30-day mortality rates were similar between the aortic balloon occlusion group (4.6%) and the conventional group (7.8%, P = 0.241). Multivariate analysis showed aortic balloon occlusion reduced postoperative acute kidney injury (23.1% vs 35.7%, P = 0.013) and hepatic injury (12.3% vs 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions: The aortic balloon occlusion achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

Download Full-text

A modified procedure in aortic arch replacement with no deep hypothermic circulatory arrest

Perfusion ◽

10.1177/0267659118781649 ◽

2018 ◽

Vol 33 (8) ◽

pp. 663-666 ◽

Cited By ~ 1

Author(s):

Yong Li ◽

Xiaogang Sun ◽

Xiuhui Zhang ◽

Yuchun Zhang ◽

Guanghui Pang ◽

...

Keyword(s):

Aortic Arch ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Deep Hypothermia ◽

Morbidity And Mortality ◽

High Morbidity ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Early Results

Deep hypothermia or circulation arrest is widely used during total aortic arch replacement. However, conventional procedures have high morbidity and mortality.1 We use the “branch-first” technique2,3 combined with clamping the distal aorta, incorporating a stented elephant trunk to avoid deep hypothermia and circulation arrest. This technique brings us closer to the goal of arch surgery without cerebral or visceral circulatory arrest and the morbidity of deep hypothermia. Early results are encouraging.

Download Full-text

Risk factor analysis of clinical outcomes of total aortic arch replacement and frozen elephant trunk with aortic balloon occlusion

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01643-3 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Luchen Wang ◽

Yunfeng Li ◽

Yaojun Dun ◽

Xiaogang Sun

Keyword(s):

Hospital Stay ◽

Aortic Arch ◽

Circulatory Arrest ◽

Balloon Occlusion ◽

Conventional Group ◽

Frozen Elephant Trunk ◽

Elephant Trunk ◽

Aortic Arch Replacement ◽

Total Aortic Arch Replacement ◽

Aortic Balloon Occlusion

Abstract Background Total aortic arch replacement (TAR) with frozen elephant trunk (FET) requires hypothermic circulatory arrest (HCA) for 20 min, which increases the surgical risk. We invented an aortic balloon occlusion (ABO) technique that requires 5 min of HCA on average to perform TAR with FET and investigated the possible merit of this new method in this study. Methods This retrospective study included consecutive patients who underwent TAR and FET (consisting of 130 cases of ABO group and 230 cases of conventional group) in Fuwai Hospital between August 2017 and February 2019. In addition to the postoperative complications, the alterations of blood routine tests, alanine transaminase (ALT) and aspartate transaminase (AST) during in-hospital stay were also recorded. Results The 30-day mortality rates were similar between ABO group (4.6%) and conventional group (7.8%, P = 0.241). Multivariate analysis showed ABO reduced postoperative acute kidney injury (23.1% vs. 35.7%, P = 0.013) and hepatic injury (12.3% vs. 27.8%, P = 0.001), and maintained similar cost to patients (25.5 vs. 24.9 kUSD, P = 0.298). We also found that AST was high during intensive care unit (ICU) stay and recovered to normal before discharge, while ALT was not as high as AST in ICU but showed a rising tendency before discharge. The platelet count showed a rising tendency on postoperative day 3 and may exceed the preoperative value before discharge. Conclusions The ABO achieved the surgical goal of TAR with FET with an improved recovery process during the in-hospital stay.

Download Full-text