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. 2019 Oct 5;132(19):2325-2332.
doi: 10.1097/CM9.0000000000000443.

Association between cardiopulmonary bypass time and 90-day post-operative mortality in patients undergoing arch replacement with the frozen elephant trunk: a retrospective cohort study

Jun Zheng  1 , Shang-Dong Xu  1 , You-Cong Zhang  1 , Kai Zhu  1 , Hui-Qiang Gao  1 , Kai Zhang  1 , Xiu-Feng Jin  1 , Tong Liu  2
Affiliations

Association between cardiopulmonary bypass time and 90-day post-operative mortality in patients undergoing arch replacement with the frozen elephant trunk: a retrospective cohort study

Jun Zheng et al. Chin Med J (Engl). .

Abstract

Background: The aortic arch replacement and cardiopulmonary bypass (CPB) are both associated with the early mortality after cardiothoracic surgery. This study aimed to investigate the relationship between CPB time and 90-day post-operative mortality in patients undergoing aortic arch surgery using the frozen elephant trunk (FET) technique with selective ante-grade cerebral perfusion (SACP).

Methods: We retrospectively reviewed data of 377 adult patients undergoing aortic arch surgery via FET with SACP from July 1, 2017 to December 31, 2018 at Beijing Anzhen Hospital. The baseline characteristics, intra-operative data, and post-operative data were collected. Univariate and multivariate Cox regression analyses were used to determine independent predictors of 90-day post-operative mortality.

Results: The 90-day post-operative mortality was 13.53%. The 78.51% of patients were men. There were 318 (84.35%) type A aortic dissections and 28 (7.43%) aortic aneurysms. Among those, 264 (70.03%) were emergency operations. Median CPB time was 202.0 (176.0, 227.0) min. Multivariate Cox regression analysis revealed that CPB time was independently associated with 90-day post-operative mortality after adjusting confounding factors (hazard ratio: 1.21/10 min increase in CPB time, 95% confidence interval: 1.15-1.27, P < 0.001). Kaplan-Meier analysis based on CPB time tertiles revealed that the top tertile (median 236.0 min) was associated with reduced survival rate compared with middle and bottom tertiles (P < 0.001). Each sub-group analysis based on the complexity of the underlying disease process showed similar associations between CPB time and 90-day post-operative mortality.

Conclusions: CPB time remains a significant factor in determining 90-day post-operative mortality in patients undergoing aortic arch surgery using FET with SACP. Surgeons should be aware of the relationship between CPB time and 90-day post-operative mortality during operative procedures and avoid extended CPB time as far as possible.

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Figures

Figure 1
Figure 1
Flow chart of this study. FET: Frozen elephant trunk; MHCA: Moderate hypothermic circulatory arrest; SACP: Selective ante-grade cerebral perfusion.
Figure 2
Figure 2
Kaplan-Meier analysis of freedom from 90-day post-operative mortality based on the CPB time tertiles (Log-rank, P < 0.001). CPB: Cardiopulmonary bypass time.
See this image and copyright information in PMC

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References

    1. Cooley DA, De Bakey ME. Resection of entire ascending aorta in fusiform aneurysm using cardiac bypass. J Am Med Assoc 1956; 162:1158–1159. doi: 10.1001/jama.1956.72970290003013a. - PubMed
    1. Laas J, Jurmann MJ, Heinemann M, Borst HG. Advances in aortic arch surgery. Ann Thorac Surg 1992; 227–232. doi: 10.1016/0003-4975(92)91323-2. - PubMed
    1. Kazui T, Kimura N, Yamada O, Komatsu S. Surgical outcome of aortic arch aneurysms using selective cerebral perfusion. Ann Thorac Surg 1994; 57:904–911. doi: 10.1016/0003-4975 (94)90201-1. - PubMed
    1. Karck M, Chavan A, Hagl C, Friedrich H, Galanski M, Haverich A. The frozen elephant trunk technique: a new treatment for thoracic aortic aneurysms. J Thorac Cardiovasc Surg 2003; 125:1550–1553. doi: 10.1016/S0022-5223(03)00045-X. - PubMed
    1. Leontyev S, Tsagakis K, Pacini D, Di Bartolomeo R, Mohr FW, Weiss G, et al. Impact of clinical factors and surgical techniques on early outcome of patients treated with frozen elephant trunk technique by using EVITA open stent-graft: results of a multicentre study. Eur J Cardiothorac Surg 2016; 49:660–666. doi: 10.1093/ejcts/ezv150. - PubMed