PMID- 18070813
OWN - NLM
STAT- MEDLINE
DCOM- 20080703
LR  - 20151119
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 7
IP  - 3
DP  - 2008 May
TI  - Repair of aortic arch and the impact of cross-clamping time, New York Heart 
      Association stage, circulatory arrest time, and age on operative outcome.
PG  - 425-9
AB  - BACKGROUND: Aortic arch replacement is associated with high morbidity and 
      mortality. METHODS: We evaluated the postoperative complications and risk factors 
      in 32 consecutive patients after aortic arch replacement. RESULTS: The mean age 
      was 61+/-15 years and male to female ratio was 24/8. Diameter of ascending aorta 
      was 6.0+/-0.8 cm and diameter of aortic arch was 5.2+/-1.2 cm. The average New 
      York heart association (NYHA) class was 2+/-1. The 30-day mortality was 6.2% (2 
      of 32 patients), one patient died intraoperatively (3%); all surviving 30 
      patients had f/u for at least six months, a total of 3 of 32 patients had died 
      within six months, actuarial survival was 90% at six months. The overall 
      incidence of neurologic adverse events was 9%; however, only one patient had a 
      cerebrovascular accident (CVA) with a focal deficit (3%). The other two patients 
      had global neurologic dysfunction. Other significant postoperative complications 
      included atrial fibrillation in 15 patients (46%), ventricular fibrillation 
      requiring cardiopulmonary resuscitation (CPR) in one patient (3%), and 
      pericardial effusion requiring pericardicentesis in eight patients (25%). The 
      need for blood transfusion correlated with the cross-clamping length (Pearson r 
      0.62; 95% confidence interval (CI), 0.35-0.79; P-value 0.0001; R(2)=0.38). 
      Cross-clamp time (139+/-58 min) did not have an impact on length of intensive 
      care unit (ICU) stay (Pearson r -0.09; 95% CI -0.39-0.23; P=0.58; R(2)=0.008) nor 
      did the length of circulatory arrest (95% CI -0.44-0.21, P=0.44). The length of 
      stay in the ICU (142+/-128 h) correlated with the NYHA stage of the patient (95% 
      CI 0.001-0.62, P=0.04). The length of stay (LOS) (12+/-6 days) correlated with 
      age of the patients (95% CI 0.03-0.57, P=0.03). CONCLUSION: Elderly patients and 
      patients with high NYHA class need close postoperative monitoring in the ICU. A 
      short circulatory arrest and aortic clamp time do not extend the LOS in ICU or in 
      the hospital.
FAU - Schwartz, Jeffrey P
AU  - Schwartz JP
AD  - Department of Thoracic Surgery, Loyola University, Chicago, IL, USA.
FAU - Bakhos, Mamdouh
AU  - Bakhos M
FAU - Patel, Amit
AU  - Patel A
FAU - Botkin, Sally
AU  - Botkin S
FAU - Neragi-Miandoab, Siyamek
AU  - Neragi-Miandoab S
LA  - eng
PT  - Journal Article
DEP - 20071210
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
CIN - Interact Cardiovasc Thorac Surg. 2008 May;7(3):429. PMID: 18495710
CIN - Interact Cardiovasc Thorac Surg. 2008 May;7(3):429. PMID: 18495711
MH  - Age Factors
MH  - Aged
MH  - Aorta, Thoracic/*surgery
MH  - Aortic Diseases/mortality/*surgery
MH  - Blood Vessel Prosthesis Implantation/*adverse effects
MH  - Constriction
MH  - Critical Care
MH  - Female
MH  - Heart Arrest, Induced/*adverse effects
MH  - Hospital Mortality
MH  - Humans
MH  - Length of Stay
MH  - Male
MH  - Middle Aged
MH  - Postoperative Care
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Severity of Illness Index
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2007/12/12 09:00
MHDA- 2008/07/04 09:00
CRDT- 2007/12/12 09:00
PHST- 2007/12/12 09:00 [pubmed]
PHST- 2008/07/04 09:00 [medline]
PHST- 2007/12/12 09:00 [entrez]
AID - icvts.2007.164871 [pii]
AID - 10.1510/icvts.2007.164871 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2008 May;7(3):425-9. doi: 
      10.1510/icvts.2007.164871. Epub 2007 Dec 10.