Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective
Objective: To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair. Methods: We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cool...
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Elsevier
2022-12-01
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| Series: | JTCVS Techniques |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666250722005326 |
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| author | Holly N. Smith, MD Akiko Tanaka, MD, PhD Max Chehadi, MS Harleen K. Sandhu, MD, MPH Charles C. Miller, III, PhD Hazim J. Safi, MD Anthony L. Estrera, MD |
| author_facet | Holly N. Smith, MD Akiko Tanaka, MD, PhD Max Chehadi, MS Harleen K. Sandhu, MD, MPH Charles C. Miller, III, PhD Hazim J. Safi, MD Anthony L. Estrera, MD |
| author_sort | Holly N. Smith, MD |
| collection | DOAJ |
| description | Objective: To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair. Methods: We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods. Incremental effect of cooling time was assessed in the context of other perfusion time variables using multiple logistic regression analysis. Results: Median age was 61 years (interquartile range, 49-70 years) and 34.1% of patients were women. The procedure was emergent in 33.5% of patients, 22.9% had a previous sternotomy. The median circulatory arrest time was 22 minutes, with retrograde cerebral perfusion used in 94% of cases. Median cardiopulmonary bypass time was 149 minutes, with an aortic crossclamp time of 90 minutes. Patients were cooled to deep hypothermia. The first quartile had cooling times ranging from 5 to 13 minutes, second 14 to 18 minutes, third 19-23 minutes, and fourth 24-81 minutes. Overall, 30-day mortality was 9.4%, and was not significantly different across quartiles. There was a statistically significant trend toward lower rates of postoperative encephalopathy, gastrointestinal complications, and respiratory failure with shorter cooling times (P < .001, .006, and < .001, respectively). There was no significant difference in rates of postoperative stroke or dialysis. Conclusions: Rapid cooling can be performed safely in patients undergoing aortic surgery requiring circulatory arrest without increasing mortality or stroke. There were significantly lower rates of coagulopathy, respiratory failure, and postoperative encephalopathy with shorter cooling times. |
| format | Article |
| id | doaj-art-8f0ce1eb4b36429b88bd95c885e80e2d |
| institution | Kabale University |
| issn | 2666-2507 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Techniques |
| spelling | doaj-art-8f0ce1eb4b36429b88bd95c885e80e2d2025-08-20T03:36:37ZengElsevierJTCVS Techniques2666-25072022-12-01161710.1016/j.xjtc.2022.09.020Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspectiveHolly N. Smith, MD0Akiko Tanaka, MD, PhD1Max Chehadi, MS2Harleen K. Sandhu, MD, MPH3Charles C. Miller, III, PhD4Hazim J. Safi, MD5Anthony L. Estrera, MD6Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexDepartment of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexDepartment of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexDepartment of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexDepartment of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexDepartment of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexAddress for reprints: Anthony L. Estrera, MD, Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, 6400 Fannin St, Suite 2850, Houston, TX 77030.; Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TexObjective: To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair. Methods: We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods. Incremental effect of cooling time was assessed in the context of other perfusion time variables using multiple logistic regression analysis. Results: Median age was 61 years (interquartile range, 49-70 years) and 34.1% of patients were women. The procedure was emergent in 33.5% of patients, 22.9% had a previous sternotomy. The median circulatory arrest time was 22 minutes, with retrograde cerebral perfusion used in 94% of cases. Median cardiopulmonary bypass time was 149 minutes, with an aortic crossclamp time of 90 minutes. Patients were cooled to deep hypothermia. The first quartile had cooling times ranging from 5 to 13 minutes, second 14 to 18 minutes, third 19-23 minutes, and fourth 24-81 minutes. Overall, 30-day mortality was 9.4%, and was not significantly different across quartiles. There was a statistically significant trend toward lower rates of postoperative encephalopathy, gastrointestinal complications, and respiratory failure with shorter cooling times (P < .001, .006, and < .001, respectively). There was no significant difference in rates of postoperative stroke or dialysis. Conclusions: Rapid cooling can be performed safely in patients undergoing aortic surgery requiring circulatory arrest without increasing mortality or stroke. There were significantly lower rates of coagulopathy, respiratory failure, and postoperative encephalopathy with shorter cooling times.http://www.sciencedirect.com/science/article/pii/S2666250722005326rapid coolingaortic surgerycardiopulmonary bypasshypothermic circulatory arrest |
| spellingShingle | Holly N. Smith, MD Akiko Tanaka, MD, PhD Max Chehadi, MS Harleen K. Sandhu, MD, MPH Charles C. Miller, III, PhD Hazim J. Safi, MD Anthony L. Estrera, MD Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective JTCVS Techniques rapid cooling aortic surgery cardiopulmonary bypass hypothermic circulatory arrest |
| title | Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective |
| title_full | Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective |
| title_fullStr | Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective |
| title_full_unstemmed | Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective |
| title_short | Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repairCentral MessagePerspective |
| title_sort | rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repaircentral messageperspective |
| topic | rapid cooling aortic surgery cardiopulmonary bypass hypothermic circulatory arrest |
| url | http://www.sciencedirect.com/science/article/pii/S2666250722005326 |
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