Document Detail


Hypothermic circulatory arrest is not a risk factor for neurologic morbidity in aortic surgery: a propensity score analysis.
MedLine Citation:
PMID:  16153918     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Hypothermic circulatory arrest has been an important tool in aortic arch surgery, even though its use has recently been discussed controversially. We sought to clarify the role of hypothermic circulatory arrest as a risk factor for mortality and neurologic morbidity in aortic surgery by using a propensity score-matching analysis. METHODS: Five hundred eleven patients (60 +/- 13 years, 349 male patients) who underwent replacement of the ascending aorta with (n = 273) or without (n = 238) arch involvement were analyzed by means of multivariate analysis. Using propensity score matching, we identified comparable patient groups: HCA(+) group and HCA(-) group (n = 110 each). For aortic arch replacement, hypothermic circulatory arrest was used with a mean duration of 14 +/- 9 minutes: 12 +/- 7 minutes or 26 +/- 8 minutes for partial or total arch replacement, respectively. RESULTS: In the entire cohort multivariate analysis identified acute dissection and duration of cardiopulmonary bypass as significant predictors for hospital death. Predictors for stroke were acute dissection, diabetes mellitus, peripheral arterial disease, and concomitant mitral valve surgery, and predictors for temporary neurologic dysfunction were peripheral arterial disease and age. After propensity score matching, the incidence of death (HCA[+]: 0.9% vs HCA[-]: 2.7%), stroke (0% vs 1.8%, respectively), and temporary neurologic dysfunction (15.5% vs 13.6%, respectively) was comparable between the 2 groups. Multivariate analysis identified age, diabetes mellitus, peripheral arterial disease, and concomitant coronary artery bypass grafting as the independent risk factors for temporary neurologic dysfunction. CONCLUSIONS: In a standard clinical setting (hypothermic circulatory arrest of <30 minutes and nasopharyngeal temperature of <20 degrees C), hypothermic circulatory arrest constitutes no significant risk for mortality or neurologic morbidity and thus appears clinically safe. Patient-related risk factors primarily determine clinical outcome.
Authors:
Takashi Kunihara; Timo Grün; Diana Aicher; Frank Langer; Oliver Adam; Olaf Wendler; Yasuaki Saijo; Hans-Joachim Schäfers
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of thoracic and cardiovascular surgery     Volume:  130     ISSN:  0022-5223     ISO Abbreviation:  J. Thorac. Cardiovasc. Surg.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-09-12     Completed Date:  2005-11-03     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376343     Medline TA:  J Thorac Cardiovasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  712-8     Citation Subset:  AIM; IM    
Affiliation:
Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Homburg, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Aorta
Aorta, Thoracic / surgery*
Aortic Aneurysm, Thoracic / surgery*
Aortic Rupture / surgery*
Blood Vessel Prosthesis Implantation
Female
Heart Arrest, Induced / adverse effects*
Hospital Mortality
Humans
Hypothermia, Induced / adverse effects*
Logistic Models
Male
Middle Aged
Multivariate Analysis
Nervous System Diseases / etiology*
Risk Factors
Stroke / etiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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