Concomitant Elective Ascending Aortic Surgery: Circulatory Arrest Does Not Affect Morbidity or Mortality

Background:
Deep hypothermic arrest (DHCA) is often employed when replacing the ascending aorta, lending more complexity to the operation. We reviewed our experience in elective cardiac surgery requiring concomitant replacement of the ascending aorta.

Methods:
A retrospective search of our database revealed 106 patients who underwent elective surgery between 1993-2015: 15 underwent isolated replacement of the ascending aorta; 3 underwent CABG; 72 valve surgery; 16 CABG + valve surgery. Patients with aortic dissection or other non-elective surgery were excluded. DHCA was employed in 86 (81%). Selective Cerebral perfusion was not employed.

Results:
For the DHCA and non-DHCA groups respectively: operative mortality was 3 (3%) and 1 (5%) (p= 0.7); renal failure 1 (1%) and 1 (5%) (p=0.3); atrial fibrillation 16 (19%) and 5 (25%) (p=0.5); pacemaker implantation 7 (8%) and 1 (5%) (p=0.6); length of stay 6±8 and 8±13 days (p=0.6). No patient suffered stroke. Within the DHCA group we compared patients undergoing >20 minutes (n=48) of arrest. We found no difference in mortality or major morbidity. By multivariate analysis, predictors of mortality were gender – female- OR 19.1 (1.5- 80.4, p- 0.05) and DM – OR- 17.4 (1.6-51.5, P- 0.03).Kaplan- Meier long term survival curves did not detect any significant differences between the two groups.

Conclusions:
In elective surgery requiring replacement of the ascending aorta, circulatory arrest does not increase operative mortality or morbidity. This can be attributed to careful patient selection, optimal myocardial as well as brain protection.