Objective:
Our aim was to investigate the relation between perioperative risk factors influencing mortality and different methods of surgical cannulation, temperature regulation and cerebral protection in patients undergoing aortic aneurysm repair surgery. For this purpose; patients requiring deep hypothermic circulatory arrest (DHCA), retrograde cerebral perfusion (RCP) and femoral or aortic cannulation were compared with patients requiring axillary cannulation, moderate hypothermic circulatory arrest (MHCA) and selective antegrade cerebral perfusion (SACP).
Material and Methods:
110 consecutive patients undergoing aortic arch aneurysm repair surgery were divided into three groups in a prospective, nonrandomized study plan depending on surgical pathology, operation and anesthesia techniques. In Group 1, femoral cannulation, DHCA (22-25°C) and RSP ; in Group 2, axillary cannulation, MHCA (26-28°C) and SACP, whereas, in Group 3, aortic cannulation, DHCA and RCP were performed. Perioperative risk factors were investigated.
Results:
In comparison of three groups, mean cross- clamping and cardiopulmonary bypass (CPB) times (min) were different (Group 1; 75.62±26.28 ve144.15±66.71, Group 2; 60.57±26.32 and 109.09±45.38, Grup 3; 72.90±23.33 and 120.83±53.46 minutes respectively, p=0.021). The comparison of mortality rates showed; in Group 1; 10/34 (29.4 %), in Group 2; 3/47 (6.4 % ) and in Group 3; 3/29 (10.3 %) patients (p=0.011). Use of IABP, heart failure, atrial rythm disturbances were found to be independent risk factors for mortality (95 % confidence interval, Hosmer and Lemeshow test, chi square=5.71, and p=0.68).
Conclusion:
In patients undergoing aortic arch repair with MHCA, SCAP and axillary cannulation, lower rates of morbidity and mortality were observed in comparison to DHCA, RCP and femoral or aortic cannulation.
Keywords: Aortic aneurysm, deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest