Arterial bypass with normothermia technique improves the early outcomes after extensive thoracoabdominal aorta repair

Abstract

Objective Conventional technique with deep hypothermia circulatory arrest (DHCA) during extensive thoracoabdominal aortic aneurysm (TAAA) repair often complicated with high mortality and neurological complications, the optimal strategy for improving outcomes after TAAA repair remains unclear. We evaluated the protective effect of arterial bypass with normothermia technique during repair of extensive TAAAs. Methods From January 2005 to June 2017, a total of 190 patients with Crawford extend Ⅱ/Ⅲ underwent extensive thoracoabdominal aortic aneurysm (TAAA) repair and either with arterial bypass plus normothermia technique (group A) or with deep hypothermia circulatory arrest (group B). In group A, 75 patients (55 men; age 40.7years; 54 patients (72%) with dissection) underwent arterial bypass procedure. In group B, 115 patients with DHCA procedure (87 men; age 38.8 years; 99 patients (66.1%) with dissection). The outcomes were compared by operative death (in-hospital death or death within 30 days of surgery) and permanent neurological complications (includes permanent stroke, paraplegia and cerebral hemorrhage). Results The operative death occurred in 1 patient (1.3%) and 9 patients (7.8%) in group A and group B (P=0.045), respectively. The permanent neurological complications occurred in 5 patients (6.7%) and 19 patients (16.7%) in group A and group B (P=0.044), respectively. Gastrointestinal dysfunction occurred in 1 patient (1.3%) in group A and in 12 patients (10.5%) in group B (P=0.015), respectively, but there were no differences in occurrence of postoperative paraplegia, stroke and cerebral hemorrhage respectively between two groups (4 patients (5.4%) vs. 9 patients (7.8%), P=0.506; 1 patients (1.3%) vs. 7 patients (6.1%), P=0.111 and 1 patients (1.3%) vs. 3 patients (2.6%), P=0.483). Multivariable analysis indicated that permanent neurological complications (OR: 13.50, 95%CI: 3.48-52.36, P=0.000) , DHCA (OR: 15.85, 95%CI: 2.64-95.13, P=0.003) , postoperative renal insufficiency (OR: 8.47, 95%CI: 2.12-33.89, P=0.003) 、gastrointestinal dysfunction (OR: 15.11, 95%CI: 3.454-66.10, P=0.000) were independent predictors for early mortality. The overall postoperative survival rate between group A and B was 98.5% vs. 90%, 96.3% vs. 90% and 96.3% vs. 83% at 3 years, 5 years and 10 years respectively; there were no significant differences between two groups for survival rate (P=0.460) . Conclusions Arterial bypass with normothermia technique improved the early outcomes with lower risk of operative death and permanent neurological complications in patients who had repair of extensive TAAAs. Key words: Arterial bypass; Deep hypothermia circulatory arrest; Total thoracic and abdominal aorta replacement