Outcomes after thoracoabdominal aortic aneurysm repair using hypothermic circulatory arrest

Kouchoukos, Nicholas T.; Kulik, Alexander; Castner, Catherine F.

doi:10.1016/j.jtcvs.2012.11.077

Cited by 93 publications

(43 citation statements)

References 9 publications

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“…Total CPB with an interval of hypothermic circulatory arrest is a widely used technique for operations on the ascending aorta and aortic arch. The main complications of aneurysmal surgery are paraplegia (2-20%) and renal failure (3-14%), both of which are normally avoidable by use of bypass or use of deep hypothermic circulatory arrest [4].…”

Section: Resultsmentioning

confidence: 99%

Aortic Aneurysm–Surgical Treatment in Apollo Hospitals, Dhaka

Sohail¹

2014

JCCR

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Marfans syndrome. Infrarenal aortic aneurysm cases were 20, thoraco abdominal aneurysm cases were 4 , dissecting aortic aneurysm cases were 2, Descending thoracic aortic aneurysm rupture were 2, Descending thoracic aortic aneurysm were 2, Descending+ascending thoracic aortic aneurysm 2. Emergency (37.5%) operations were 12 cases :-6 cases were infrarenal leaking aneurysm, 2 cases were leaking abdominal aortic aneurysm, 2 cases were dissecting aortic aneurysm, 2 cases were Descending thoracic aortic aneurysm rupture. Methods: This is a retrograde study, was done in Apollo Hospitals Dhaka from 21st December, 2006 to 12th July 2014. 32 patients were operated. Age range was from 22 to 81 years (mean 55.33), male 28, female 4. Infrarenal aortic aneurysm cases were 20, thoraco abdominal aneurysm cases were 4, dissectingaortic aneurysm cases were 2 (CABG+Bracheocephalic artery reimplantation with 8 mm graft), Descending thoracic aortic aneurysm rupture cases were 2, Descending thoracic aortic aneurysm cases were 2, Descending thoracic aortic aneurysm + Bentall procedures were--2. Emergency (37.5%) operations were 12 cases :-6 cases were infrarenal leaking aneurysm, 2 cases were leaking abdominal aortic aneurysm, 2 cases were dissecting aortic aneurysm, 2 cases were Descending thoracic aortic aneurysm rupture.Results: Overall mortality rate was 15.62% (5 cases). Among emergency cases there were 6.25% (2 cases) death rate, per operative one -Descending thoracic aorta rupture in a 75 years old gentleman. Another lady of 35 years died 3 months later where emergency surgery was done for dissecting aortic aneurysm. In routine cases mortality rate was 9.37% (3 cases) -1 month later a case of thoraco abdominal aneurysm dieddue to diabetic complication, 1 month later 22 years old gentleman (Descending thoracic aortic aneurysm with Bentall procedure) diedas a complication of tracheostomy (tracheo-innominate artery fistula) -sudden severe bleeding; another death in 46 years old gentleman where graft leakage occurred4 years after abdominal aortic aneurysm repair. Rest of the patients arein continuous follow up with us and are doing well. Conclusion:Surgical repair for aortic aneurysm has a good long-term outcome.

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Section: Resultsmentioning

confidence: 99%

Aortic Aneurysm–Surgical Treatment in Apollo Hospitals, Dhaka

Sohail¹

2014

JCCR

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“…At the same time, the rate of paraplegia was only 1% and the rate of stroke was 9%. The largest patient series to date, published in 2013 by Kouchoukos et al ,29 evaluated use of DHCA in 243 patients with TAAAs. Their series showed 7.8% mortality, 5.3% spinal cord ischaemia (3.7% paraplegia), 3.7% stroke and 3.6% renal failure.…”

Section: Recent Therapeutic Developments That Have Improved Outcomesmentioning

confidence: 99%

“…Kouchoukos et al 29 have shown excellent results using this technique and argue, that since hypothermia increases ischaemic tolerance of the visceral organs, there is no need for adjunctive selective perfusion of the kidneys and intestines. The Mount Sinai group has also found that DHCA is effective in reducing the incidence of renovisceral morbidity after TAAA repair 30…”

Section: Recent Therapeutic Developments That Have Improved Outcomesmentioning

confidence: 99%

Surgical management of thoracoabdominal aneurysms

Ziganshin

Elefteriades

2014

Heart

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Thoracoabdominal aneurysm of the aorta (TAAA) is a morbid condition, the treatment of which can be associated with high mortality and complication rates, as well as prolonged length of hospital stay. Currently, three approaches to treatment of TAAAs exist: open, endovascular and hybrid repair. Over the past three decades, a significant decrease in postoperative mortality and paraplegia rates has been achieved due to effective application of such treatment adjuncts as left heart bypass, cerebrospinal fluid drainage, application of hypothermia and neuromonitoring, thereby making surgical treatment of TAAAs increasingly safer for the patient. In this report, we review indications and current approaches to surgical management of TAAAs, as well as the factors that influence the efficacy of this type of treatment.

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“…Experienced surgeons and centers report operative mortality rates of 5-8% and paraplegia rates of 3-8% (4)(5)(6)(7). Furthermore, open surgical repair of TAAA is the best option for patients with connective tissue disorders or systemic vasculitis, who are not good candidates for endovascular treatment (8).…”

Section: Introductionmentioning

confidence: 99%

Thoracoabdominal aortic aneurysm (extent II) repair in a patient with systemic vasculitis

Kim

2016

J. Vis. Surg.

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Conventional open repair is a gold standard for treating thoracoabdominal aortic aneurysm (TAAA) in patients with connective tissue disorders or systemic vasculitis. In a 42-year-old male patient with systemic vasculitis, TAAA extent II open repair was performed at our hospital. Here, we present the case with a video clip and technical tips. were almost within the normal range.After weighing the relative risk of the TAAA repair-first strategy as compared to the brain aneurysm-first treatment, we decided to proceed with the TAAA open repair first under the consent and complete understanding of the patient and his family. Pre-operative preparationA double-lumen endotracheal tube was inserted. Arterial pressure monitoring cannulas were inserted in the right radial artery and the right dorsalis pedis artery. A cerebrospinal fluid (CSF) drain was inserted to measure the CSF pressure and to remove the fluid. The CSF pressure was maintained within the 10-12 mmHg range. A cell-saving device was prepared. Somatosensory-or motor-evoked potential monitoring was not used.The patient was placed in a modified right lateral decubitus position (shoulders at 90 degrees from the horizontal plane and hips at 45 degrees) using a bean-bag device and position tools. Equipment preference card ProcedureThe left thoracoabdominal incision was made, and the pleural cavity was entered through the 6 th intercostal space. Lung adhesion to the proximal descending thoracic aorta (DTA) was encountered. Once the space required for performing a longitudinal aortotomy was obtained, we avoided performing additional adhesiolysis to prevent lung injury. Aortic clamp sites on the proximal descending aorta, mid-descending aorta, distal descending aorta, and both iliac arteries were prepared using umbilical tapes.After full heparinization, partial cardio-pulmonary bypass (CPB) was instituted using the left femoral artery and femoral vein cannula. Distal perfusion and upper body hypertension during aortic cross-clamping were controlled by reduction of the preload and increase of lower body perfusion. The advantage of partial CPB is safe control of volume loss during massive bleeding by using the pump suckers and reservoir. Permissive mild hypothermia (32-34 ℃, nasopharyngeal) was maintained.For this patient with systemic vasculitis, Gelweave Coselli 22 mm thoracoabdominal graft (Vascutek Ltd, Inchinnan, Scotland) was chosen. In patients with connective tissue disorder or systemic vasculitis, separate anastomoses of mesenteric arteries are preferred over island patch anastomosis to prevent the development of late pseudoaneurysm at the suture sites (10).To minimize the ischemic time of organs, sequential aortic clamping and aortic opening were performed. Throughout the whole procedure, the expected hypotension and acidosis after removal of the aortic cross-clamp was managed with aggressive fluid resuscitation and sodium bicarbonate infusion (11).With respect to the segmental arteries, T9 and T10 segmental arteries were reattached to the main gra...

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Outcomes after thoracoabdominal aortic aneurysm repair using hypothermic circulatory arrest

Cited by 93 publications

References 9 publications

Aortic Aneurysm–Surgical Treatment in Apollo Hospitals, Dhaka

Aortic Aneurysm–Surgical Treatment in Apollo Hospitals, Dhaka

Surgical management of thoracoabdominal aneurysms

Thoracoabdominal aortic aneurysm (extent II) repair in a patient with systemic vasculitis

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