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The Journal of Thoracic and Cardiovascular Surgery, Vol 106, 19-28, Copyright © 1993 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
LG Svensson, ES Crawford, KR Hess, JS Coselli, S Raskin, SA Shenaq and HJ Safi
We have retrospectively evaluated our results after aortic surgery in
adults using deep hypothermia with circulatory arrest to determine the
patient predictors of early death and postoperative stroke by logistic
regression analysis. Of the 656 patients operated on between July 7, 1979,
and January 30, 1991, 43% (n = 283) were female, the median age of the
patients was 64 years (range 10 to 88 years), 12% (n = 77) had acute
dissection, 26% (n = 173) had previously undergone either cardiac or
ascending aortic operations, and 13% (n = 85) had a history of
cerebrovascular disease. Eighty-four patients underwent elephant trunk
procedures. The median circulatory arrest time was 31 minutes (range 7 to
120 minutes). The univariable predictors of transient or permanent stroke,
defined as clinical evidence of neurologic injury, either global or
hemiparetic, which occurred in 44 patients (7%), were as follows (p <
0.05): increased age; a history of cerebrovascular disease; circulatory
arrest time (7 to 29 minutes = 12/298 [4%], 30 to 44 minutes = 15/201
[7.5%], 45 to 59 minutes 9/84 [10.7%], 60 to 120 minutes 7/48 [14.6%];
cardiopulmonary bypass time; and concurrent descending thoracic aorta
repair. The multivariably determined predictors were as follows (p <
0.05): a history of cerebrovascular disease; previous aortic surgery distal
to the left subclavian artery; and cardiopulmonary bypass time. A history
of aortic valve incompetence, however, was associated with a lower risk of
stroke (adjusted odds ratio 0.42, p = 0.015). The multivariably determined
predictors for increased risk of early death (p < 0.05), which occurred
in 66 (10%) patients, were as follows: increased age; Marfan syndrome;
concurrent distal aortic aneurysm; previous ascending aortic operation;
cardiopulmonary bypass time; cardiac complications; renal complications;
and stroke. In this study, the occurrence of stroke was observed to
increase after 40 minutes of circulatory arrest; furthermore, the mortality
rate increased markedly after 65 minutes of circulatory arrest. Thus the
"safe" period for strokes not developing appeared to be limited to
approximately 40 minutes. We conclude that deep hypothermia with
circulatory arrest is a safe technique for the repair of complex aortic
problems provided both the circulatory arrest and the cardiopulmonary
bypass times are not excessive. In addition, the clinical characteristics
of the patients are important determinants of stroke and death.
ARTICLES
Deep hypothermia with circulatory arrest. Determinants of stroke and early mortality in 656 patients
Department of Surgery, Baylor College of Medicine, Houston, Tex.
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M. Di Eusanio, M. E. S.H. Tan, M. A.A.M. Schepens, K. M. Dossche, R. Di Bartolomeo, A. Pierangeli, and W. J. Morshuis Surgery for acute type A dissection using antegrade selective cerebral perfusion: experience with 122 patients Ann. Thorac. Surg., February 1, 2003; 75(2): 514 - 519. [Abstract] [Full Text] [PDF]
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N. T. Kouchoukos, P. Masetti, and C. K. Rokkas Single-stage replacement of the thoracic aorta Ann. Thorac. Surg., October 1, 2002; 74(4): 1292 - 1292. [Full Text] [PDF]
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D. T. Lai, R. C. Robbins, R. S. Mitchell, K. A. Moore, P. E. Oyer, N. E. Shumway, B. A. Reitz, and D. C. Miller Does Profound Hypothermic Circulatory Arrest Improve Survival in Patients With Acute Type A Aortic Dissection? Circulation, September 24, 2002; 106(12_suppl_1): I-218 - I-228. [Abstract] [Full Text] [PDF]
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T. Caus, J. M. Frapier, R. Giorgi, T. Aymard, A. Riberi, B. Albat, P. A. Chaptal, and T. Mesana Clinical outcome after repair of acute type A dissection in patients over 70 years-old Eur. J. Cardiothorac. Surg., August 1, 2002; 22(2): 211 - 217. [Abstract] [Full Text] [PDF]
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O. Tasdemir, A. Saritas, S. Kucuker, M. A. Ozatik, and E. Sener Aortic arch repair with right brachial artery perfusion Ann. Thorac. Surg., June 1, 2002; 73(6): 1837 - 1842. [Abstract] [Full Text] [PDF]
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R. S. Bonser, C. H. Wong, D. Harrington, D. Pagano, M. Wilkes, T. Clutton-Brock, and M. Faroqui Failure of retrograde cerebral perfusion to attenuate metabolic changes associated with hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., May 1, 2002; 123(5): 943 - 950. [Abstract] [Full Text] [PDF]
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J. S. Coselli and S. A. LeMaire Temperature management after hypothermic circulatory arrest J. Thorac. Cardiovasc. Surg., April 1, 2002; 123(4): 621 - 623. [Full Text] [PDF]
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D. Harrington, C. H. Wong, and R. S. Bonser Neurological Complications of Aortic Surgery Seminars in Cardiothoracic and Vascular Anesthesia, March 1, 2002; 6(1): 7 - 16. [Abstract] [PDF]
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W. A. L. Soong, S. Uysal, and D. L. Reich Cerebral Protection During Surgery of the Aortic Arch Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 286 - 292. [Abstract] [PDF]
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E. A. Hessel Bypass Techniques for Descending Thoracic Aortic Surgery Seminars in Cardiothoracic and Vascular Anesthesia, November 1, 2001; 5(4): 293 - 320. [Abstract] [PDF]
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L. J. Goldstein, R. R. Davies, J. A. Rizzo, J. J. Davila, M. R. Cooperberg, R. K. Shaw, G. S. Kopf, and J. A. Elefteriades Stroke in surgery of the thoracic aorta: Incidence, impact, etiology, and prevention J. Thorac. Cardiovasc. Surg., November 1, 2001; 122(5): 935 - 945. [Abstract] [Full Text] [PDF]
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N. Washiyama, T. Kazui, M. Takinami, K. Yamashita, S. Fujita, H. Terada, K. Suzuki, B. A. H. Muhammad, M. Fujie, and S. Yamamoto Experimental study on the effect of antegrade cerebral perfusion on brains with old cerebral infarction J. Thorac. Cardiovasc. Surg., October 1, 2001; 122(4): 734 - 740. [Abstract] [Full Text] [PDF]
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T. M. Beaver and T. D. Martin Single-stage transmediastinal replacement of the ascending, arch, and descending thoracic aorta Ann. Thorac. Surg., October 1, 2001; 72(4): 1232 - 1238. [Abstract] [Full Text] [PDF]
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Y. Okita, K. Minatoya, O. Tagusari, M. Ando, K. Nagatsuka, and S. Kitamura Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion Ann. Thorac. Surg., July 1, 2001; 72(1): 72 - 79. [Abstract] [Full Text] [PDF]
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R. Di Bartolomeo, M. Di Eusanio, D. Pacini, M. Pagliaro, C. Savini, A. Nocchi, and A. Pierangeli Antegrade selective cerebral perfusion during surgery of the thoracic aorta: risk analysis Eur. J. Cardiothorac. Surg., June 1, 2001; 19(6): 765 - 770. [Abstract] [Full Text] [PDF]
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L. G. Svensson, E. M. Nadolny, D. L. Penney, J. Jacobson, W. A. Kimmel, M. H. Entrup, and R. S. D'Agostino Prospective randomized neurocognitive and S-100 study of hypothermic circulatory arrest, retrograde brain perfusion, and antegrade brain perfusion for aortic arch operations Ann. Thorac. Surg., June 1, 2001; 71(6): 1905 - 1912. [Abstract] [Full Text] [PDF]
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S. A. LeMaire, J. K. Bhama, Z. C. Schmittling, P. J. Oberwalder, C. Koksoy, S. A. Raskin, P. E. Curling, and J. S. Coselli S100{beta} correlates with neurologic complications after aortic operation using circulatory arrest Ann. Thorac. Surg., June 1, 2001; 71(6): 1913 - 1919. [Abstract] [Full Text] [PDF]
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E. M. Nadolny and L. G. Svensson Hypothermic arrest for descending aortic rupture in reoperative patients Ann. Thorac. Surg., June 1, 2001; 71(6): 2027 - 2030. [Abstract] [Full Text] [PDF]
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C. Hagl, M. A. Ergin, J. D. Galla, S. L. Lansman, J. N. McCullough, D. Spielvogel, P. Sfeir, C. A. Bodian, and R. B. Griepp Neurologic outcome after ascending aorta-aortic arch operations: Effect of brain protection technique in high-risk patients J. Thorac. Cardiovasc. Surg., June 1, 2001; 121(6): 1107 - 1121. [Abstract] [Full Text] [PDF]
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D. L. Ngaage, D. A.C. Sharpe, S. Prescott, and P. H. Kay Safe technique for removal of extensive renal cell tumors Ann. Thorac. Surg., May 1, 2001; 71(5): 1679 - 1681. [Abstract] [Full Text] [PDF]
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K. Kawahito, H. Adachi, A. Yamaguchi, and T. Ino Preoperative risk factors for hospital mortality in acute type A aortic dissection Ann. Thorac. Surg., April 1, 2001; 71(4): 1239 - 1243. [Abstract] [Full Text] [PDF]
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T. Kazui, N. Washiyama, B. A. H. Muhammad, H. Terada, K. Yamashita, and M. Takinami Improved results of atherosclerotic arch aneurysm operations with a refined technique J. Thorac. Cardiovasc. Surg., March 1, 2001; 121(3): 491 - 499. [Abstract] [Full Text] [PDF]
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K. Orihashi, Y. Matsuura, T. Sueda, H. Shikata, M. Watari, and K. Okada Clinical implication of orbital ultrasound monitoring during selective cerebral perfusion Ann. Thorac. Surg., February 1, 2001; 71(2): 673 - 677. [Abstract] [Full Text] [PDF]
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R. Sinatra, G. Melina, I. Pulitani, B. Fiorani, G. Ruvolo, and B. Marino Emergency operation for acute type A aortic dissection: neurologic complications and early mortality Ann. Thorac. Surg., January 1, 2001; 71(1): 33 - 38. [Abstract] [Full Text] [PDF]
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T. Hirotani, T. Kameda, T. Kumamoto, and S. Shirota Aortic arch repair using hypothermic circulatory arrest technique associated with pharmacological brain protection Eur. J. Cardiothorac. Surg., November 1, 2000; 18(5): 545 - 549. [Abstract] [Full Text] [PDF]
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T. Ueda, H. Shimizu, T. Ito, I. Kashima, K. Hashizume, Y. Iino, and S. Kawada Cerebral complications associated with selective perfusion of the arch vessels Ann. Thorac. Surg., November 1, 2000; 70(5): 1472 - 1477. [Abstract] [Full Text] [PDF]
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H. Takano, T. Sakakibara, R. Matsuwaka, T. Hori, N. Sakagoshi, and N. Shinohara The safety and usefulness of cool head-warm body perfusion in aortic surgery Eur. J. Cardiothorac. Surg., September 1, 2000; 18(3): 262 - 269. [Abstract] [Full Text] [PDF]
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 R S Bonser, D Pagano, M E Lewis, S J Rooney, P Guest, P Davies, and I Shimada Clinical and patho-anatomical factors affecting expansion of thoracic aortic aneurysms Heart, September 1, 2000; 84(3): 277 - 283. [Abstract] [Full Text] [PDF]
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R. Di Bartolomeo, D. Pacini, M. Di Eusanio, and A. Pierangeli Antegrade selective cerebral perfusion during operations on the thoracic aorta: our experience Ann. Thorac. Surg., July 1, 2000; 70(1): 10 - 15. [Abstract] [Full Text] [PDF]
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M. P. Ehrlich, M. A. Ergin, J. N. McCullough, S. L. Lansman, J. D. Galla, C. A. Bodian, A. Z. Apaydin, and R. B. Griepp Predictors of adverse outcome and transient neurological dysfunction after ascending aorta/hemiarch replacement Ann. Thorac. Surg., June 1, 2000; 69(6): 1755 - 1763. [Abstract] [Full Text] [PDF]
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C. Wong and R. S. Bonser Retrograde perfusion and true reverse brain blood flow in humans Eur. J. Cardiothorac. Surg., May 1, 2000; 17(5): 597 - 601. [Abstract] [Full Text] [PDF]
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K. M. Dossche, W. J. Morshuis, M. A. Schepens, and F. G. Waanders Bilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta Eur. J. Cardiothorac. Surg., April 1, 2000; 17(4): 462 - 467. [Abstract] [Full Text] [PDF]
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