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Aortic Symposium 2010

Routine Hypothermia with Circulatory Arrest and Retrograde Cerebral Perfusion for Ascending Aortic Reconstruction. Division of Cardiac Surgery Brigham and Women’s Hospital. Andrew W. ElBardissi, MD, MPH Sary F. Aranki, MD Lawrence H. Cohn, MD Stanton K. Shernan , MD

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Aortic Symposium 2010

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  1. Routine Hypothermia with Circulatory Arrest and Retrograde Cerebral Perfusion for Ascending Aortic Reconstruction Division of Cardiac SurgeryBrigham and Women’s Hospital Andrew W. ElBardissi, MD, MPH Sary F. Aranki, MD Lawrence H. Cohn, MD Stanton K. Shernan, MD Daniel J. FitzGerald, CCP, LP R. Morton Bolman III, MD Aortic Symposium 2010

  2. Natural History of Aneurysmal Disease

  3. Background • Aneurysmal ascending aortic degeneration includes aortic tissue proximal to the innominate artery • Aortic cross-clamping leaves a segment of aneurysmal distal ascending aorta

  4. Surgical Result following Reconstruction Open Distal Anastomosis Closed Distal Anastomosis

  5. Objective • Evaluate outcomes of elective ascending aortic reconstruction with open distal anastomosis (with RCP) versus closed distal anastomosis with aortic cross-clamping.

  6. Methods 687 patients with Ascending Aortic Reconstruction (2005-Present) Aortic Dissections Complex aortic arch reconstructions 305 patients 110 open distal (OD) anastomosis with RCP 195 closed distal (CD) anastomosis 1:1 Propensity Matching 99 CD 99 OD

  7. Methods • Primary endpoint • CVA • Temporary Neurologic Deficit • Ventilator Hours • ICU Hours • Length of Stay • Secondary endpoint • 30-day mortality • Intermediate-term Survival

  8. Preoperative Characteristics

  9. Operative Characteristics

  10. 1.00 0.95 0.90 0.85 0.80 0.75 0.70 0.65 0.60 0.55 0.50 0.00 300 900 1200 Follow-up (days) Results P=0.44 P=0.42 P=0.57 P=0.20 P=0.52 n=2 n=1 n=2 P=0.30 No difference in 30 day (OD, 0% vs. CD, 1%, p=0.59) or Intermediate-term Mortality

  11. Conclusions • Open distal reconstruction of ascending aorta in AAA repair • No difference in operative mortality, stroke, temporary neurologic deficit, ventilator hours, ICU hours, or LOS compared to closed distal with aortic x-clamping • Should be considered as a routine treatment strategy, as it allows removal of AA in its entirety

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