scholarly journals Long-Term Out come Evaluation in Patient Undergoing Deep Hypo-thermic Circulatory Arrest in Aortic Arch Surgery

2021 ◽  
Vol 04 (05) ◽  
Author(s):  
Leibuss Roberts ◽  
Keyword(s):  
Quality Of Life ◽  
Aortic Arch ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Surgery ◽  
Questionnaire Score ◽  
Increased Risk

Background: Aortic dissection is usually associated with low survival rates due to high prehospital and perioperative mortality, in addition with increased risk of postoperative complication in survivals. Since 1985, deep hypothermic circulatory arrest (DHCA) is often used in aortic arch surgery with main advantage to provide bloodless surgical field while protecting brain tissue during hypothermia. Nevertheless, it still raises concern of increasing neurologic sequelae and a potential decrease of long-term quality of life. The aim of study: To evaluate the effect of DHCA used in aortic surgery on long-term quality of life. Methods: In this observational case series we included a total of 24 patients who had aortic arch surgery requiring DHCA in the Pauls Stradins Clinical University Hospital Cardiac Surgery center, from January 2019 to December 2020. Seven patients were excluded due to intrahospital death. For the rest of the patients Quality of life (QOL) was evaluated using RAND SF36 questionnaire and MMSE test. Data regarding demographics, clinical characteristics, surgery type, duration of circulatory arrest, rectal and bladder temperatures were collected and analyzed using the SPSS 23 Statistics software IBM SPSS Statistics 21 (IBM Corporation, NY, USA). Statistical significance was assumed as two- tailed p <0.05. Results: A total of 17 patients were analyzed, we had 12 (71%) males and 5 (29%) females. A mean age was 60.71 (±13.8 SD) years, leading co-morbidity was hypertension – 11 (64.7%). There were 6 (35.3%) elective and 11 (64.7%) acute surgeries. Stan-ford A dissection (82.4%) constituted the main part of all cases. A 94.7% had aortic arch replacement. Most common postopera-tive complication was wound infection- 29.4%. The mean cardiopulmonary bypass time, aortic cross-clamping and reperfusion time was 212 (±38.3, SD), 124 (±33.8, SD) and 70.2 (±32.9, SD) minutes, respectively. Core temperature during DHCA was 23.2 Cº (±3.2, SD) and a rewarming rate was 0.12 (±0.07, SD) Cº/min. No significance correlation between RAND SF36 questionnaire score (QoL questionnaire) and lowest DHCA temperature, aortic cross - clamping, reperfusion time, CPB time was observed, respectively - p=0.367, p=0.544, p=0.619, p=0. We found statistically significant moderate strength correlation between QOL and rewarming rate (r=0.550; p=0.022). Mean RAND SF36 questionnaire score was 71.9±10. and mean MMSE score was 27.9±5,3. Conclusions: We found no correlation between quality of life and lowest temperature during surgery, aortic cross- clamping time, reperfusion time, however we found positive moderate strength correlation between rewarming rate and quality of life. Patient quality of life after surviving aortic arch surgery and deep hypothermic circulatory arrest compared to general healthy population quality of life is slightly reduced. Mini-mental state exam and RANDO short form health survey can be useful scoring system to evaluate patient quality of life.

scholarly journals Hypothermic circulatory arrest with or without antegrade cerebral perfusion for aortic arch surgery in infants

2019 ◽  
Vol 1 (3) ◽  
pp. 99-104
Author(s):  
Mohamed Abdel Fouly
Keyword(s):  
Cerebral Infarction ◽  
Aortic Arch ◽  
Cerebral Perfusion ◽  
Circulatory Arrest ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Aortic Arch Surgery ◽  
Significant Difference ◽  
Arch Reconstruction ◽  
Antegrade Cerebral Perfusion

Background: Antegrade cerebral perfusion (ACP) minimizes deep hypothermic circulatory arrest (DHCA) duration during arch surgery in infants, which may impact the outcomes of the repair. We aimed to evaluate the effect of adding antegrade cerebral perfusion to deep hypothermic circulatory arrest on DHCA duration and operative outcomes of different aortic arch operations in infants. Methods: We retrospectively collected data from infants (<20 weeks old) who underwent aortic arch reconstruction (Norwood operation, arch reconstruction for the hypoplastic arch and interrupted aortic arch) using DHCA alone (n=88) or combined with ACP (n=26). We excluded patients who had concomitant procedures and those with preoperative neurological disability. Results: There was no difference between groups as regards the age, gender, and the operation performed (p= 0.64; 0.87 and 0.50; respectively). Among the 114 patients, 11 (9.6%) had operative mortality, and 14 (12.3%) had cerebral infarction diagnosed with CT scanning. Adding ACP to DHCA significantly reduced DHCA duration from 50.7 ± 10.6 minutes to 22.4 ± 6.2 minutes (p<0.001) and lowered the mortality (11 vs. 0; p=0.066) and cerebral infarction (13 vs. 1; p=0.18). No statistically significant difference between the two groups in terms of ischemic time (p=0.63) or hospital stay duration (p=0.47). Conclusion: Using ACP appears to reduce the DHCA duration and was associated with better survival and neurological outcomes of aortic arch surgery in infants. A study with longer follow-up to evaluate the long-term neurological sequelae is recommended.

scholarly journals Long-Term Survival and Quality of Life After Hypothermic Circulatory Arrest in Aortic Surgery

2018 ◽  
Vol 107 (4) ◽  
pp. 322-328 ◽  
Author(s):  
J. A. Stewart ◽  
V. H. Ilkka ◽  
J. J. Jokinen ◽  
A. P. Vakkuri ◽  
R. T. Suojaranta ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Health Related Quality ◽  
Term Survival ◽  
Long Term Survival ◽  
Related Quality ◽  
Health Related

Background and Aims: Hypothermic circulatory arrest carries a high risk of mortality and neurological complications. An important part of assessing surgical treatment is the evaluation of long-term survival and postoperative health-related quality of life. Material and Methods: In this prospective study, 30 patients undergoing hypothermic circulatory arrest during surgery of the thoracic aorta, and 31 comparison patients undergoing elective coronary artery surgery without hypothermic circulatory arrest were evaluated for long-term survival and health-related quality of life, using the RAND 36-Item Health Survey questionnaire. The results were compared to national age- and sex-matched reference populations of the chronically ill and healthy adults. Results: After 4.6–8.0 years, available study (88%) and comparison (59%) patients were interviewed. The life expectancy was similar with 4- and 8-year survival of 90%, and 87% for the study group, and 94%, and 94% for the comparison group, respectively (log rank test, p = 0.62). The RAND-36 scores for study and comparison groups were congruent in all dimensions, describing physical, mental, and social domains. The study patients’ health-related quality of life results were similar to the national reference population with chronic illnesses. Conclusion: After hypothermic circulatory arrest, patients undergoing surgery of the thoracic aorta achieve a similar long-term life expectancy and health-related quality of life as do patients undergoing coronary surgery without hypothermic circulatory arrest, and a health-related quality of life similar to the national reference population with chronic illnesses. These results justify operative treatment in this high-risk patient population.

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