Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair
Objective With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. Methods F...
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| Veröffentlicht in: | The Journal of thoracic and cardiovascular surgery 2013-03, Vol.145 (3), p.S72-S77 |
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| creator | Iba, Yutaka, MD Minatoya, Kenji, MD, PhD Matsuda, Hitoshi, MD, PhD Sasaki, Hiroaki, MD, PhD Tanaka, Hiroshi, MD, PhD Kobayashi, Junjiro, MD, PhD Ogino, Hitoshi, MD, PhD |
| description | Objective With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. Methods From 2001 to 2011, 1007 patients (median age, 72 years) underwent open arch repair with selective cerebral perfusion through the right axillary artery and hypothermic circulatory arrest: deep ( |
| doi_str_mv | 10.1016/j.jtcvs.2012.11.047 |
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We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. Methods From 2001 to 2011, 1007 patients (median age, 72 years) underwent open arch repair with selective cerebral perfusion through the right axillary artery and hypothermic circulatory arrest: deep (<25°C) in 48% and moderate (25°-28°C) in 52%. Of the 1007 patients, 73% underwent total arch replacement and 26% emergent surgery for aneurysm rupture or acute aortic dissection. Results The early mortality was 4.7% for all patients. Permanent and temporary neurologic dysfunction occurred in 3.5% and 6.7%, respectively. No spinal cord injury occurred, even with moderate hypothermia. The independent predictors of in-hospital mortality included chronic obstructive pulmonary disease, liver dysfunction, chronic kidney disease, and concomitant coronary artery bypass. The independent predictors of permanent neurologic dysfunction included cerebrovascular disease, emergency surgery, and concomitant coronary artery bypass. The cumulative survival rate was 80.4% and 71.2% at 5 and 8 years, respectively. Freedom from reoperation related to the initial arch repair was 98.0% and 96.9% at 5 and 8 years, respectively. Conclusions Conventional open arch repair yielded satisfactory outcomes and should remain the standard therapy, with good long-term durability in all but high-risk patients.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2012.11.047</identifier><identifier>PMID: 23260455</identifier><language>eng</language><publisher>United States: Mosby, Inc</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Aorta, Thoracic - physiopathology ; Aorta, Thoracic - surgery ; Aortic Diseases - mortality ; Aortic Diseases - physiopathology ; Aortic Diseases - surgery ; Axillary Artery ; Blood Vessel Prosthesis Implantation - adverse effects ; Blood Vessel Prosthesis Implantation - mortality ; Cardiothoracic Surgery ; Cerebrovascular Circulation ; Child ; Circulatory Arrest, Deep Hypothermia Induced ; Elective Surgical Procedures ; Emergencies ; Endovascular Procedures - adverse effects ; Endovascular Procedures - mortality ; Female ; Humans ; Kaplan-Meier Estimate ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Perfusion - adverse effects ; Perfusion - methods ; Perfusion - mortality ; Postoperative Complications - mortality ; Postoperative Complications - surgery ; Reoperation ; Retrospective Studies ; Risk Factors ; Time Factors ; Treatment Outcome ; Young Adult</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2013-03, Vol.145 (3), p.S72-S77</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2013 The American Association for Thoracic Surgery</rights><rights>Copyright © 2013 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c459t-33adb57e4f1a68eb9ae59cc088a58520daf3cf7b568490e8e543af4a43b940613</citedby><cites>FETCH-LOGICAL-c459t-33adb57e4f1a68eb9ae59cc088a58520daf3cf7b568490e8e543af4a43b940613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0022522312014882$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23260455$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Iba, Yutaka, MD</creatorcontrib><creatorcontrib>Minatoya, Kenji, MD, PhD</creatorcontrib><creatorcontrib>Matsuda, Hitoshi, MD, PhD</creatorcontrib><creatorcontrib>Sasaki, Hiroaki, MD, PhD</creatorcontrib><creatorcontrib>Tanaka, Hiroshi, MD, PhD</creatorcontrib><creatorcontrib>Kobayashi, Junjiro, MD, PhD</creatorcontrib><creatorcontrib>Ogino, Hitoshi, MD, PhD</creatorcontrib><title>Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. Methods From 2001 to 2011, 1007 patients (median age, 72 years) underwent open arch repair with selective cerebral perfusion through the right axillary artery and hypothermic circulatory arrest: deep (<25°C) in 48% and moderate (25°-28°C) in 52%. Of the 1007 patients, 73% underwent total arch replacement and 26% emergent surgery for aneurysm rupture or acute aortic dissection. Results The early mortality was 4.7% for all patients. Permanent and temporary neurologic dysfunction occurred in 3.5% and 6.7%, respectively. No spinal cord injury occurred, even with moderate hypothermia. The independent predictors of in-hospital mortality included chronic obstructive pulmonary disease, liver dysfunction, chronic kidney disease, and concomitant coronary artery bypass. The independent predictors of permanent neurologic dysfunction included cerebrovascular disease, emergency surgery, and concomitant coronary artery bypass. The cumulative survival rate was 80.4% and 71.2% at 5 and 8 years, respectively. Freedom from reoperation related to the initial arch repair was 98.0% and 96.9% at 5 and 8 years, respectively. Conclusions Conventional open arch repair yielded satisfactory outcomes and should remain the standard therapy, with good long-term durability in all but high-risk patients.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aorta, Thoracic - physiopathology</subject><subject>Aorta, Thoracic - surgery</subject><subject>Aortic Diseases - mortality</subject><subject>Aortic Diseases - physiopathology</subject><subject>Aortic Diseases - surgery</subject><subject>Axillary Artery</subject><subject>Blood Vessel Prosthesis Implantation - adverse effects</subject><subject>Blood Vessel Prosthesis Implantation - mortality</subject><subject>Cardiothoracic Surgery</subject><subject>Cerebrovascular Circulation</subject><subject>Child</subject><subject>Circulatory Arrest, Deep Hypothermia Induced</subject><subject>Elective Surgical Procedures</subject><subject>Emergencies</subject><subject>Endovascular Procedures - adverse effects</subject><subject>Endovascular Procedures - mortality</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Perfusion - adverse effects</subject><subject>Perfusion - methods</subject><subject>Perfusion - mortality</subject><subject>Postoperative Complications - mortality</subject><subject>Postoperative Complications - surgery</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkbuO1DAUhi0EYoeFJ0BCLmkSjm-JU4CERtyklSgAic5ynBONQ8YOdjJo3x4Ps0tBQ3Wa_6Lz_YQ8Z1AzYM2rqZ5Wd8o1B8ZrxmqQ7QOyY9C1VaPV94dkB8B5pTgXV-RJzhMAtMC6x-SKC96AVGpH4j6GFY9LTDbd0rhgoDam1TtqkzvQhIv1if7y64FmnNGt_oTUYcI-2ZkumMYt-xioD3Q9IMVkaRwphiGebHbbbNN93iXqKXk02jnjs7t7Tb69f_d1_7G6-fzh0_7tTeWk6tZKCDv0qkU5Mtto7DuLqnMOtLZKKw6DHYUb2141WnaAGpUUdpRWir6T0DBxTV5ecpcUf26YV3P02eE824Bxy4Zx3cmW80YWqbhIXYo5JxzNkvyx4DAMzJm0mcwf0uZM2jBmCunienFXsPVHHP567tEWweuLAMubJ4_JZOcxOBx8KhzNEP1_Ct7843ezD97Z-QfeYp7ilkIhaJjJ3ID5ch77vDUrIVJrLn4DlganQg</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Iba, Yutaka, MD</creator><creator>Minatoya, Kenji, MD, PhD</creator><creator>Matsuda, Hitoshi, MD, PhD</creator><creator>Sasaki, Hiroaki, MD, PhD</creator><creator>Tanaka, Hiroshi, MD, PhD</creator><creator>Kobayashi, Junjiro, MD, PhD</creator><creator>Ogino, Hitoshi, MD, PhD</creator><general>Mosby, Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair</title><author>Iba, Yutaka, MD ; Minatoya, Kenji, MD, PhD ; Matsuda, Hitoshi, MD, PhD ; Sasaki, Hiroaki, MD, PhD ; Tanaka, Hiroshi, MD, PhD ; Kobayashi, Junjiro, MD, PhD ; Ogino, Hitoshi, MD, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c459t-33adb57e4f1a68eb9ae59cc088a58520daf3cf7b568490e8e543af4a43b940613</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aorta, Thoracic - physiopathology</topic><topic>Aorta, Thoracic - surgery</topic><topic>Aortic Diseases - mortality</topic><topic>Aortic Diseases - physiopathology</topic><topic>Aortic Diseases - surgery</topic><topic>Axillary Artery</topic><topic>Blood Vessel Prosthesis Implantation - adverse effects</topic><topic>Blood Vessel Prosthesis Implantation - mortality</topic><topic>Cardiothoracic Surgery</topic><topic>Cerebrovascular Circulation</topic><topic>Child</topic><topic>Circulatory Arrest, Deep Hypothermia Induced</topic><topic>Elective Surgical Procedures</topic><topic>Emergencies</topic><topic>Endovascular Procedures - adverse effects</topic><topic>Endovascular Procedures - mortality</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Perfusion - adverse effects</topic><topic>Perfusion - methods</topic><topic>Perfusion - mortality</topic><topic>Postoperative Complications - mortality</topic><topic>Postoperative Complications - surgery</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Iba, Yutaka, MD</creatorcontrib><creatorcontrib>Minatoya, Kenji, MD, PhD</creatorcontrib><creatorcontrib>Matsuda, Hitoshi, MD, PhD</creatorcontrib><creatorcontrib>Sasaki, Hiroaki, MD, PhD</creatorcontrib><creatorcontrib>Tanaka, Hiroshi, MD, PhD</creatorcontrib><creatorcontrib>Kobayashi, Junjiro, MD, PhD</creatorcontrib><creatorcontrib>Ogino, Hitoshi, MD, PhD</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Iba, Yutaka, MD</au><au>Minatoya, Kenji, MD, PhD</au><au>Matsuda, Hitoshi, MD, PhD</au><au>Sasaki, Hiroaki, MD, PhD</au><au>Tanaka, Hiroshi, MD, PhD</au><au>Kobayashi, Junjiro, MD, PhD</au><au>Ogino, Hitoshi, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>145</volume><issue>3</issue><spage>S72</spage><epage>S77</epage><pages>S72-S77</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><abstract>Objective With the recent advance of endovascular aortic repair, conventional open repair for aortic arch lesions should be reassessed. We reviewed our contemporary open arch repair with selective antegrade cerebral perfusion by way of the axillary artery with deep or moderate hypothermia. Methods From 2001 to 2011, 1007 patients (median age, 72 years) underwent open arch repair with selective cerebral perfusion through the right axillary artery and hypothermic circulatory arrest: deep (<25°C) in 48% and moderate (25°-28°C) in 52%. Of the 1007 patients, 73% underwent total arch replacement and 26% emergent surgery for aneurysm rupture or acute aortic dissection. Results The early mortality was 4.7% for all patients. Permanent and temporary neurologic dysfunction occurred in 3.5% and 6.7%, respectively. No spinal cord injury occurred, even with moderate hypothermia. The independent predictors of in-hospital mortality included chronic obstructive pulmonary disease, liver dysfunction, chronic kidney disease, and concomitant coronary artery bypass. The independent predictors of permanent neurologic dysfunction included cerebrovascular disease, emergency surgery, and concomitant coronary artery bypass. The cumulative survival rate was 80.4% and 71.2% at 5 and 8 years, respectively. Freedom from reoperation related to the initial arch repair was 98.0% and 96.9% at 5 and 8 years, respectively. Conclusions Conventional open arch repair yielded satisfactory outcomes and should remain the standard therapy, with good long-term durability in all but high-risk patients.</abstract><cop>United States</cop><pub>Mosby, Inc</pub><pmid>23260455</pmid><doi>10.1016/j.jtcvs.2012.11.047</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Aorta, Thoracic - physiopathology Aorta, Thoracic - surgery Aortic Diseases - mortality Aortic Diseases - physiopathology Aortic Diseases - surgery Axillary Artery Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - mortality Cardiothoracic Surgery Cerebrovascular Circulation Child Circulatory Arrest, Deep Hypothermia Induced Elective Surgical Procedures Emergencies Endovascular Procedures - adverse effects Endovascular Procedures - mortality Female Humans Kaplan-Meier Estimate Logistic Models Male Middle Aged Multivariate Analysis Perfusion - adverse effects Perfusion - methods Perfusion - mortality Postoperative Complications - mortality Postoperative Complications - surgery Reoperation Retrospective Studies Risk Factors Time Factors Treatment Outcome Young Adult |
| title | Contemporary open aortic arch repair with selective cerebral perfusion in the era of endovascular aortic repair |
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