Outcomes after thoracoabdominal aortic aneurysm repair using hypothermic circulatory arrest

To evaluate our experience with thoracoabdominal aortic aneurysm repair using cardiopulmonary bypass and hypothermic circulatory arrest.

A total of 243 patients underwent thoracoabdominal aortic aneurysm repair with full cardiopulmonary bypass and hypothermic circulatory arrest. The degree of repair was Crawford extent I in 63 (26%), Crawford extent II in 97 (40%), and Crawford extent III in 83 patients (34%). Degenerative aneurysms were the most frequent indication for surgery, and 18 patients (7.4%) required emergency surgery.

The mean duration of cardiopulmonary bypass and hypothermic circulatory arrest was 160 ± 44 and 31 ± 12 minutes, respectively. Stroke occurred in 9 patients (3.7%) and spinal cord ischemic injury in 13 patients (5.3%; 9 with paraplegia and 4 with paraparesis). Temporary dialysis for new-onset renal failure was required in 3.6% of hospital survivors. The 30-day mortality rate was 7.8% (13 patients). It was 33.3% after emergency surgery and 5.6% after elective surgery (P = .001). Spinal cord ischemic injury occurred more frequently after emergency than after elective surgery (16.7% vs 3.9%; P = .04). The overall 5-year survival was 55% and was significantly better for patients with nondegenerative aortic disease.

Cardiopulmonary bypass with hypothermic circulatory arrest can be safely used for thoracoabdominal aortic aneurysm repair, providing excellent protection against end-organ injury. The early and late mortality rates did not exceed those reported for other open techniques or for endovascular repair, with particularly favorable outcomes among patients undergoing elective repair.