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Damberg, Anneke; Carino, Davide; Charilaou, Paris; Peterss, Sven; Tranquilli, Maryann; Ziganshin, Bulat A.; Rizzo, John A.; Elefteriades, John A. (2017): Favorable late survival after aortic surgery under straight deep hypothermic circulatory arrest. In: Journal of thoracic and Cardiovascular Surgery, Vol. 154, No. 6: pp. 1831-1839
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Background: Surgical and cerebral protection strategies in aortic arch surgery remain under debate. Perioperative results using deep hypothermic circulatory arrest (DHCA) have been associated with favorable short-term mortality and stroke rates. The present study focuses on late survival in patients undergoing aortic surgery using DHCA. Methods: A total of 613 patients (mean age, 63.7 years) underwent aortic surgery between January 2003 and December 2015 using DHCA, with 77.3% undergoing hemiarch replacement and 20.4% undergoing arch replacement, with a mean DHCA duration of 29.7 +/- 8.5 minutes (range, 10-62 minutes). We examined follow-up extending up to a mean of 3.8 +/- 3.4 years (range, 0-14.1 years). Results: Operative mortality was 2.9%, and the stroke rate was 2%. Survival was 92.2% at 1 year and 81.5% at 5 years, significantly lower than the values in an age-and sex-matched reference population. In elective, nondissection first-time surgeries (n = 424), survival was similar to that of the reference group. Acute type A aortic dissection (hazard ratio [HR], 4.84;P = .000), redo (HR, 4.12;P = .000), and descending aortic pathology (HR, 5.54: P = .000) were independently associated with reduced 1-year survival. Beyond 1 year, age (HR, 1.07;P = .000), major complications (HR, 3.11;P = .000), and atrial fibrillation (HR, 2.47;P = .006) were independently associated with poor survival. DHCA time was not significantly associated with survival in multivariable analysis. Conclusions: Aortic surgery with DHCA can be performed with favorable late survival, with the duration of DHCA period having only a limited impact. However, these results cannot be generalized for very long durations of DHCA (>50 minutes), when perfusion methods may be preferable. In elective, nondissection first-time surgeries, a late survival comparable to that in a reference population can be achieved. Early survival is adversely affected by aortic dissection, redo status, and disease extent.