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A Journal on Cardiac, Vascular and Thoracic Surgery

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The Journal of Cardiovascular Surgery 2010 June;51(3):423-8

language: English

Does hypothermic circulatory arrest or prolonged cardiopulmonary bypass time affect early outcome in reoperative aortic surgery?

Chamogeorgakis T. P. 1, Anagnostopoulos C. E. 1,3, Kostopanagiotou G. 2, Angouras D. C. 1, Toumpoulis I. K. 1, Matiatou S. 2, Georgiannakis M. C. 1, Mallios D. 1, Rokkas C. K. 1

1 Department of Cardiothoracic Surgery, University of Athens School of Medicine, “Attikon” Hospital Center, Athens, Greece;
2 Second Department of Anesthesiology, University of Athens School of Medicine, “Attikon” Hospital Center, Athens, Greece;
3 Department of Cardiothoracic Surgery, St. Luke’s/Roosevelt Hospital Center at Columbia University, New York, NY, USA


AIM: Prolonged cardio-pulmonary bypass (CPB) time, usually necessary for reoperations, is known to increase mortality in coronary bypass procedures and aortic reoperations. We investigated if prolonged CPB time and arch reconstruction in reoperations of the thoracic aorta affect in-hospital outcome.
METHODS: Twenty-nine patients underwent reoperations on the thoracic aorta. The reoperations performed were aortic root replacement with composite graft without aortic arch involvement in ten patients, isolated ascending aorta replacement in six patients, aortic arch replacement as a primary procedure in two patients, and aortic arch in conjunction with ascending or descending aorta replacement in 11 patients.
RESULTS: Fourteen patients had aortic reoperation with deep hypothermic circulatory arrest (DHCA) and 15 without DHCA. The in-hospital mortality rate was 13.8%. The use deep hypothermic circulatory arrest or CPB time did not affect early outcome. Previous coronary artery bypass procedure was independent predictor of in-hospital mortality. Seven patients required re-exploration for bleeding. One patient suffered from stroke and finally five patients had prolonged ventilation, two requiring tracheostomy. There have been no deaths in the follow-up period. None of the patients has required repeat surgical intervention on the heart or the aorta.
CONCLUSION: The use of DHCA or prolonged CPB time do not affect early outcome in reoperations of the thoracic aorta.

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