Download PDF
CC BY 4.0 · Aorta (Stamford) 2021; 09(02): 060-066
DOI: 10.1055/s-0041-1725073
Original Research Article

Reoperative Aortic Arch Surgery under Mild Systemic Hypothermia: Two-Center Experience

Petar Risteski 
1   Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
,
Isabel Radacki
1   Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
,
Andreas Zierer
2   Department of Cardiac, Vascular, and Thoracic Surgery, Kepler University Hospital, Linz, Austria
,
Aris Lenos
3   Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
,
Anton Moritz
1   Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany
,
Paul P. Urbanski
3   Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Background The aim of the study was to assess the indications, surgical strategies, and outcomes after reoperative aortic arch surgery performed generally under mild hypothermia.

Methods Ninety consecutive patients (60 males, mean age, 55 ± 16 years) underwent open reoperative aortic arch surgery after previous cardiac aortic surgery. The indications included chronic-progressive arch aneurysm (55.5%), chronic aortic dissection (17.8%), contained arch rupture (16.7%), and graft infection (10%). The reoperation was performed through a repeat sternotomy (96%) or clamshell thoracotomy (4%) using antegrade cerebral perfusion under mild systemic hypothermia (28.9 ± 2.5°C) in all except three patients.

Results The surgery comprised hemiarch or total arch replacement in 41 (46%) and 49 (54%) patients, respectively. The distal extension included classic or frozen elephant trunk technique, each in 12 patients, and total descending aorta replacement in 4 patients. Operative mortality was 6 (6.7%) among all patients, with age identified as the only independent predictor of operative mortality (p = 0.05). Permanent and transient neurologic deficits occurred in 1% and 9% of the patients, respectively. Estimated survival at 8 years was 59 ± 8% with advanced heart failure predictive for late mortality (p = 0.014). Freedom from second reoperation or intervention on the aorta was 78 ± 6% at 8 years, with most of these events occurring downstream in patients with chronic degenerative aneurysms.

Conclusion Aortic arch reoperations performed using antegrade cerebral perfusion under mild systemic hypothermia offer favorable operative outcomes with an exceptionally low rate of neurologic morbidity without any difference between hemiarch and complex arch procedures.

Keywords

aortic arch surgery - reoperation - mild hypothermia


Publication History

Received: 20 January 2020

Accepted: 02 October 2020

Article published online:
07 October 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Etz CD, Plestis KA, Homann TM. et al. Reoperative aortic root and transverse arch procedures: a comparison with contemporaneous primary operations. J Thorac Cardiovasc Surg 2008; 136 (04) 860-867 , 867.e1–867.e3
    CrossrefPubMedGoogle Scholar
  • 2 Malvindi PG, van Putte BP, Sonker U, Heijmen RH, Schepens MAAM, Morshuis WJ. Reoperation after acute Type a aortic dissection repair: a series of 104 patients. Ann Thorac Surg 2013; 95 (03) 922-927
    CrossrefPubMedGoogle Scholar
  • 3 Quintana E, Bajona P, Schaff HV. et al. Open aortic arch reconstruction after previous cardiac surgery: outcomes of 168 consecutive operations. J Thorac Cardiovasc Surg 2014; 148 (06) 2944-2950
    CrossrefPubMedGoogle Scholar
  • 4 Bajona P, Quintana E, Schaff HV. et al. Aortic arch surgery after previous Type A dissection repair: results up to 5 years. Interact Cardiovasc Thorac Surg 2015; 21 (01) 81-85 , discussion 85–86
    CrossrefPubMedGoogle Scholar
  • 5 Moz M, Misfeld M, Leontyev S, Borger MA, Davierwala P, Mohr FW. Aortic arch reoperation in a single centre: early and late results in 57 consecutive patients. Eur J Cardiothorac Surg 2013; 44 (01) e82-e86
    CrossrefPubMedGoogle Scholar
  • 6 Preventza O, Price MD, Simpson KH. et al. Hemiarch and total arch surgery in patients with previous repair of acute Type I aortic dissection. Ann Thorac Surg 2015; 100 (03) 833-838
    CrossrefPubMedGoogle Scholar
  • 7 Preventza O, Garcia A, Cooley DA. et al. Reprint of: Reoperations on the total aortic arch in 119 patients: short- and mid-term outcomes, focusing on composite adverse outcomes and survival analysis. J Thorac Cardiovasc Surg 2015; 149 (2, suppl): S59-S64
    CrossrefPubMedGoogle Scholar
  • 8 Di Bartolomeo R, Berretta P, Pantaleo A. et al. Long-term outcomes of open arch repair after a prior aortic operation: our experience in 154 patients. Ann Thorac Surg 2017; 103 (05) 1406-1412
    CrossrefPubMedGoogle Scholar
  • 9 Preventza O, Garcia A, Kashyap SA. et al. Moderate hypothermia ≥24 and ≤28°C with hypothermic circulatory arrest for proximal aortic operations in patients with previous cardiac surgery. Eur J Cardiothorac Surg 2016; 50 (05) 949-954
    CrossrefPubMedGoogle Scholar
  • 10 Rastan AJ, Walther T, Alam NA. et al. Moderate versus deep hypothermia for the arterial switch operation--experience with 100 consecutive patients. Eur J Cardiothorac Surg 2008; 33 (04) 619-625
    CrossrefPubMedGoogle Scholar
  • 11 Tsai JY, Pan W, Lemaire SA. et al. Moderate hypothermia during aortic arch surgery is associated with reduced risk of early mortality. J Thorac Cardiovasc Surg 2013; 146 (03) 662-667
    CrossrefPubMedGoogle Scholar
  • 12 Di Eusanio M, Berretta P, Bissoni L, Petridis FD, Di Marco L, Di Bartolomeo R. Re-operations on the proximal thoracic aorta: results and predictors of short- and long-term mortality in a series of 174 patients. Eur J Cardiothorac Surg 2011; 40 (05) 1072-1076
    PubMedGoogle Scholar
  • 13 Zierer A, Detho F, Dzemali O, Aybek T, Moritz A, Bakhtiary F. Antegrade cerebral perfusion with mild hypothermia for aortic arch replacement: single-center experience in 245 consecutive patients. Ann Thorac Surg 2011; 91 (06) 1868-1873
    CrossrefPubMedGoogle Scholar
  • 14 Urbanski PP, Lenos A, Lindemann Y, Weigang E, Zacher M, Diegeler A. Carotid artery cannulation in aortic surgery. J Thorac Cardiovasc Surg 2006; 132 (06) 1398-1403
    CrossrefPubMedGoogle Scholar
  • 15 Zierer A, El-Sayed Ahmad A, Papadopoulos N, Moritz A, Diegeler A, Urbanski PP. Selective antegrade cerebral perfusion and mild (28°C-30°C) systemic hypothermic circulatory arrest for aortic arch replacement: results from 1002 patients. J Thorac Cardiovasc Surg 2012; 144 (05) 1042-1049
    CrossrefPubMedGoogle Scholar
  • 16 Urbanski PP. Carotid artery and jugular vein cannulation in aortic redo surgery. J Thorac Cardiovasc Surg 2012; 143 (05) 1227-1229
    CrossrefPubMedGoogle Scholar
  • 17 Kirmani BH, Brazier A, Sriskandarajah S, Azzam R, Keenan DJ. A meta-analysis of computerized tomography scan for reducing complications following repeat sternotomy for cardiac surgery. Interact Cardiovasc Thorac Surg 2016; 22 (04) 472-479
    CrossrefPubMedGoogle Scholar
  • 18 El-Sayed Ahmad A, Papadopoulos N, Moritz A, Zierer A. Treatment of a giant ascending aortic pseudoaneurysm presenting as a presternal pulsatile protrusion almost perforating through the skin. Interact Cardiovasc Thorac Surg 2013; 16 (06) 903-905
    CrossrefPubMedGoogle Scholar
  • 19 Leshnower BG, Kilgo PD, Chen EP. Total arch replacement using moderate hypothermic circulatory arrest and unilateral selective antegrade cerebral perfusion. J Thorac Cardiovasc Surg 2014; 147 (05) 1488-1492
    CrossrefPubMedGoogle Scholar
  • 20 Preventza O, Coselli JS, Garcia A. et al. Moderate hypothermia at warmer temperatures is safe in elective proximal and total arch surgery: Results in 665 patients. J Thorac Cardiovasc Surg 2017; 153 (05) 1011-1018
    CrossrefPubMedGoogle Scholar