[Surgical outcomes of off-pump technique in extensive thoracoabdominal aorta replacement]

To assess the safety and efficacy of off-pump technique with normothemia to extend thoracoabdominal aortic aneurysm replacement compared with traditional hypothermic circulatory arrest.

From January 2004 to December 2013, 128 consecutive patients underwent surgical repair of thoracoabdominal aortic aneurysm (type Crawford Ⅱ) in Fuwai Hospital. The mean age was (37±11) years. The patients included 74 cases (57.8%) with chronic Stanford A dissection, 34 cases (26.6%) with chronic Stanford B dissection, 20 cases (15.6%) with thoracoabdominal aortic true aneurysm. There were 71 patients who underwent hypothermic circulatory arrest surgery (cardiopulmonary bypass (CPB) group) and 57 patients who underwent off-pump surgery with normothermia (off-pump group). The clinic data was compared between the 2 groups using paired t tests and χ(2) test. Kaplan-Meier survival analysis was used for postoperative survival stays.

The mean CPB time in CPB group was (251 ±87) minuets and the circulatory arrest time was (45±24) minuets. Spinal cord ischemia time in the two groups was (21±12) minuets and (18±10) minuets (t=5.68, P=0.51). The operation time, ventilator time, length of ICU stay and length of hospital stay of off-pump group were shorter than CPB group ((408±114) minuets vs.(630±156) minuets, t=-7.67, P=0.05; (18±13) hours vs. (113±89) hours, t=-3.86, P=0.00; (4±2) days vs.(10±9) days, t=-4.19, P=0.00; (15±7) days vs.(25±14) days, t=-4.47, P=0.00). The intraoperative blood loss in off-pump group and CPB group was (900±750) ml and (1 400±400) ml (t=-2.23, P=0.04). The mortality was 1.7% and 9.8% in the off-pump group and CPB groups (χ(2)=3.544, P=0.05). The cerebral complication rate in the normal temperature group was 1.7% vs. 22.6% in extracorporeal group (χ(2)=9.35, P<0.05). A total of 113 patients were followed up, with a follow-up rate of 88.2%. Duration of follow-up was (78±54) months. Five patients died during the follow-up period, including 2 who died of cerebral infarction and 3 paraplegia patients who died of infection. Eight patients had phase Ⅱ aortic arch replacement after a mean time of 6 months. The overall postoperative survival rate was 97%, 93% and 87% at 3 years, 5 years and 7 years, respectively.

Off-pump technique with normothemia was associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of extensive thoracoabdominal aortic aneurysm.