Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest: Quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention

John G. Augoustides, Thomas F. Floyd, Michael L. McGarvey, E. Andrew Ochroch, Alberto Pochettino, Shelly Fulford, Andrew J. Gambone, Justin Weiner, Sushma Raman, Joseph S. Savino, Joseph E. Bavaria, David R. Jobes

Research output: Contribution to journalArticle

48 Citations (Scopus)

Abstract

Objective: The purpose of this study was to describe clinical outcome after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA), to determine mortality and length of stay, neurologic outcome, cardiorespiratory outcome, and hemostatic and renal outcome after DHCA. Design: Retrospective and observational. Setting: Cardiothoracic operating rooms and intensive care unit (ICU). Participants: All adults requiring thoracic aortic repair with DHCA. Interventions: None. The study was observational. Main Results: The cohort size was 110. All patients received an antifibrinolytic. The mortality rate was 8.2%. The mean length of stay was 6.8 days (ICU) and 14.0 days (hospital). The incidence of stroke was 8.1% and postoperative delirium was 10.9%. The rate of postoperative atrial fibrillation was 43.6%; 19.1% required postoperative mechanical ventilation longer than 72 hours. Chest tube drainage was 931 mL for the first 24 hours. Postoperative dialysis was required in 1.8% of patients. Renal dysfunction occurred in 40% to 50% of patients, depending on the definition. Conclusions: The protocol for DHCA at the authors' institution is associated with superior or equivalent perioperative outcomes to those reported in the literature. This study identified the need for further quantification of the clinical outcomes after DHCA in order to prioritize outcome-based hypothesis-driven prospective intervention in DHCA.

Original languageEnglish (US)
Pages (from-to)446-452
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume19
Issue number4
DOIs
StatePublished - Aug 1 2005

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Deep Hypothermia Induced Circulatory Arrest
Thoracic Surgery
Intensive Care Units
Length of Stay
Kidney
Chest Tubes
Antifibrinolytic Agents
Mortality
Delirium
Hemostatics
Operating Rooms
Artificial Respiration
Atrial Fibrillation
Nervous System
Observational Studies
Dialysis
Drainage
Thorax
Stroke
Incidence

Keywords

  • Atrial fibrillation
  • Deep hypothermic circulatory arrest
  • Delirium
  • Dialysis
  • Perioperative outcome
  • Renal dysfunction
  • Stroke
  • Thoracic aortic surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

Cite this

Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest : Quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention. / Augoustides, John G.; Floyd, Thomas F.; McGarvey, Michael L.; Ochroch, E. Andrew; Pochettino, Alberto; Fulford, Shelly; Gambone, Andrew J.; Weiner, Justin; Raman, Sushma; Savino, Joseph S.; Bavaria, Joseph E.; Jobes, David R.

In: Journal of Cardiothoracic and Vascular Anesthesia, Vol. 19, No. 4, 01.08.2005, p. 446-452.

Research output: Contribution to journalArticle

Augoustides, John G. ; Floyd, Thomas F. ; McGarvey, Michael L. ; Ochroch, E. Andrew ; Pochettino, Alberto ; Fulford, Shelly ; Gambone, Andrew J. ; Weiner, Justin ; Raman, Sushma ; Savino, Joseph S. ; Bavaria, Joseph E. ; Jobes, David R. / Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest : Quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention. In: Journal of Cardiothoracic and Vascular Anesthesia. 2005 ; Vol. 19, No. 4. pp. 446-452.
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AU - Floyd, Thomas F.

AU - McGarvey, Michael L.

AU - Ochroch, E. Andrew

AU - Pochettino, Alberto

AU - Fulford, Shelly

AU - Gambone, Andrew J.

AU - Weiner, Justin

AU - Raman, Sushma

AU - Savino, Joseph S.

AU - Bavaria, Joseph E.

AU - Jobes, David R.

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AB - Objective: The purpose of this study was to describe clinical outcome after adult thoracic aortic surgery requiring standardized deep hypothermic circulatory arrest (DHCA), to determine mortality and length of stay, neurologic outcome, cardiorespiratory outcome, and hemostatic and renal outcome after DHCA. Design: Retrospective and observational. Setting: Cardiothoracic operating rooms and intensive care unit (ICU). Participants: All adults requiring thoracic aortic repair with DHCA. Interventions: None. The study was observational. Main Results: The cohort size was 110. All patients received an antifibrinolytic. The mortality rate was 8.2%. The mean length of stay was 6.8 days (ICU) and 14.0 days (hospital). The incidence of stroke was 8.1% and postoperative delirium was 10.9%. The rate of postoperative atrial fibrillation was 43.6%; 19.1% required postoperative mechanical ventilation longer than 72 hours. Chest tube drainage was 931 mL for the first 24 hours. Postoperative dialysis was required in 1.8% of patients. Renal dysfunction occurred in 40% to 50% of patients, depending on the definition. Conclusions: The protocol for DHCA at the authors' institution is associated with superior or equivalent perioperative outcomes to those reported in the literature. This study identified the need for further quantification of the clinical outcomes after DHCA in order to prioritize outcome-based hypothesis-driven prospective intervention in DHCA.

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