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Aortic root surgery in combination with hypothermic circulatory arrest: preserve or replace the aortic valve in the context of postoperative neurological outcome? A case match comparison.
- Source :
-
Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2009 Aug; Vol. 9 (2), pp. 246-50. Date of Electronic Publication: 2009 May 01. - Publication Year :
- 2009
-
Abstract
- The objective of this study was to compare the results of elective composite (C) vs. David (D) operations in patients requiring additional aortic arch surgery using hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion (SACP), with the focus on postoperative neurological outcome and quality of life (SF-36). Between November 1999 and March 2006, 333 patients underwent aortic root surgery and ascending aortic replacement with HCA and SACP at our institution. Out of these patients, 46 were matched with respect to age, gender, HCA-time and year of surgery. Two patients, one in each group, died during hospital stay (4%), with no late deaths. Follow-up was completed in 95% [64 (6-90) months]. Cardiopulmonary bypass (CPB) time (141 min vs. 168 min, P=0.007) and aortic cross-clamp time (99 min vs. 123 min, P=0.004) were significantly longer in the David-group. The incidence of temporary neurological dysfunction (TND 7%: D n=1, C n=2) was not different between groups, no permanent dysfunction could be detected. Follow-up SF-36 scores were comparable. The combination of aortic arch surgery with more time consuming valve sparing aortic root surgery does not increase the risk for adverse outcome applying comparable periods of HCA and SACP.
- Subjects :
- Aged
Aortic Diseases complications
Aortic Diseases mortality
Blood Vessel Prosthesis Implantation mortality
Cardiopulmonary Bypass
Case-Control Studies
Cerebrovascular Circulation
Cerebrovascular Disorders mortality
Cerebrovascular Disorders physiopathology
Circulatory Arrest, Deep Hypothermia Induced mortality
Constriction
Female
Heart Valve Diseases complications
Heart Valve Diseases mortality
Heart Valve Prosthesis Implantation mortality
Humans
Male
Middle Aged
Neurologic Examination
Patient Selection
Perfusion
Quality of Life
Risk Assessment
Risk Factors
Surveys and Questionnaires
Time Factors
Treatment Outcome
Aortic Diseases surgery
Aortic Valve surgery
Blood Vessel Prosthesis Implantation adverse effects
Cerebrovascular Disorders etiology
Circulatory Arrest, Deep Hypothermia Induced adverse effects
Heart Valve Diseases surgery
Heart Valve Prosthesis Implantation adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1569-9285
- Volume :
- 9
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Interactive cardiovascular and thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 19411260
- Full Text :
- https://doi.org/10.1510/icvts.2008.194811