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Repair of aortic arch and the impact of cross-clamping time, New York Heart Association stage, circulatory arrest time, and age on operative outcome

^a Departments of Thoracic and Cardiovascular Surgery, Loyola University, Chicago, IL, USA
^b Department of Surgery, Case Western Reserve University Hospital and Metro Health System, Cleveland, OH, USA

*Corresponding author. Present address: Departments of Surgery and Cardiothoracic Surgery, Boston University Medical Center, One Boston Medical Center Place, Boston, MA 02118, USA. Tel.: +1 617 935 2782; fax: +1 216 844 8201.

E-mail address: sneragi{at}yahoo.com (S. Neragi-Miandoab).

Background: Aortic arch replacement is associated with high morbidity and mortality. Methods: We evaluated the postoperative complications and risk factors in 32 consecutive patients after aortic arch replacement. Results: The mean age was 61±15 years and male to female ratio was 24/8. Diameter of ascending aorta was 6.0±0.8 cm and diameter of aortic arch was 5.2±1.2 cm. The average New York heart association (NYHA) class was 2±1. The 30-day mortality was 6.2% (2 of 32 patients), one patient died intraoperatively (3%); all surviving 30 patients had f/u for at least six months, a total of 3 of 32 patients had died within six months, actuarial survival was 90% at six months. The overall incidence of neurologic adverse events was 9%; however, only one patient had a cerebrovascular accident (CVA) with a focal deficit (3%). The other two patients had global neurologic dysfunction. Other significant postoperative complications included atrial fibrillation in 15 patients (46%), ventricular fibrillation requiring cardiopulmonary resuscitation (CPR) in one patient (3%), and pericardial effusion requiring pericardicentesis in eight patients (25%). The need for blood transfusion correlated with the cross-clamping length (Pearson r 0.62; 95% confidence interval (CI), 0.35–0.79; P-value 0.0001; R²=0.38). Cross-clamp time (139±58 min) did not have an impact on length of intensive care unit (ICU) stay (Pearson r –0.09; 95% CI –0.39–0.23; P=0.58; R²=0.008) nor did the length of circulatory arrest (95% CI –0.44–0.21, P=0.44). The length of stay in the ICU (142±128 h) correlated with the NYHA stage of the patient (95% CI 0.001–0.62, P=0.04). The length of stay (LOS) (12±6 days) correlated with age of the patients (95% CI 0.03–0.57, P=0.03). Conclusion: Elderly patients and patients with high NYHA class need close postoperative monitoring in the ICU. A short circulatory arrest and aortic clamp time do not extend the LOS in ICU or in the hospital.

Key Words: Thoracic aorta; Aortic arch; Aortic rupture; Hypothermic circulatory arrest

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