CONTEMPORARY OUTCOMES OF AORTIC ARCH REPAIR WITH HYPOTHERMIC CIRCULATORY ARREST: THE IMPACT OF URGENCY STATUS EVIDENCE FROM THE CANADIAN THORACIC AORTIC COLLABORATIVE
CCC ePoster Library. Ghoneim A. 10/26/19; 280529; 294
Dr. Aly Ghoneim
Dr. Aly Ghoneim
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Abstract
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BACKGROUND: The aim of this study was to analyze the contemporary outcomes of patients undergoing aortic arch surgery with hypothermic circulatory arrest (HCA), according to their urgency status.

METHODS AND RESULTS: A total of 2624 patients (62 years (0.3), 70% male, 63% elective vs 37 % non-elective) who underwent aortic arch repair with HCA among 12 Canadian centres between 2002 and 2018 (Figure.1). Elective patients were compared to non-elective (urgent, emergent & salvage surgery) for early in-hospital outcomes ( < 30 days). Overall in-hospital mortality occurred in 218 (8.3%) patients, with higher mortality in non-elective vs elective patients (15.7% vs 2.4%, p < 0.001). Adverse neurological events occurred in 307 patients (11.7%) [stroke 207 (7.9%), spinal cord injury 34 (1.3%) and transient ischemic attack 66 (2.9%)] with more neurological events in non-elective vs elective patients (15.6% vs 8.1%, p < 0.001). The risk of stroke was significantly higher in the non-elective group [n=114 (11.6%)] vs the elective group [n=91 (5.6%)]; p < 0.001). Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion were employed in 1805 (70.1%) and 275 (10.7%) patients respectively, however, 373 (14.2%) patients underwent circulatory arrest with hypothermia alone.

CONCLUSION: This contemporary series demonstrated the safety of cerebral circulatory arrest with good outcomes when conducted in cardiac surgery centres with aortic expertise. Nonetheless, mortality and morbidity remain higher in non-elective patients, hence, further research is needed to improve outcomes in non-elective aortic arch surgery
BACKGROUND: The aim of this study was to analyze the contemporary outcomes of patients undergoing aortic arch surgery with hypothermic circulatory arrest (HCA), according to their urgency status.

METHODS AND RESULTS: A total of 2624 patients (62 years (0.3), 70% male, 63% elective vs 37 % non-elective) who underwent aortic arch repair with HCA among 12 Canadian centres between 2002 and 2018 (Figure.1). Elective patients were compared to non-elective (urgent, emergent & salvage surgery) for early in-hospital outcomes ( < 30 days). Overall in-hospital mortality occurred in 218 (8.3%) patients, with higher mortality in non-elective vs elective patients (15.7% vs 2.4%, p < 0.001). Adverse neurological events occurred in 307 patients (11.7%) [stroke 207 (7.9%), spinal cord injury 34 (1.3%) and transient ischemic attack 66 (2.9%)] with more neurological events in non-elective vs elective patients (15.6% vs 8.1%, p < 0.001). The risk of stroke was significantly higher in the non-elective group [n=114 (11.6%)] vs the elective group [n=91 (5.6%)]; p < 0.001). Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion were employed in 1805 (70.1%) and 275 (10.7%) patients respectively, however, 373 (14.2%) patients underwent circulatory arrest with hypothermia alone.

CONCLUSION: This contemporary series demonstrated the safety of cerebral circulatory arrest with good outcomes when conducted in cardiac surgery centres with aortic expertise. Nonetheless, mortality and morbidity remain higher in non-elective patients, hence, further research is needed to improve outcomes in non-elective aortic arch surgery
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