In-hospital stay
Intraoperative results are presented in Table 2. The right axillary artery is the most frequent artery for cannulation (n=33, 58.9%). Brain protection was achieved with bilateral perfusion in most of the patients (n=47, 83.9%). The E-vita Open prosthesis was deployed in Zone 2 in 42 cases (75%). CPB, myocardial ischemia, SACP and lower body circulatory arrest times were 183±49 min, 109±40 min, 75±28 min and 42±18 min, respectively.
As our experience grew (Figure 1) indications expanded and the technique evolved (Table 2). Thereby, main indications for surgery in group I were degenerative aneurysms (56%, n=14), and surgery was elective in 76% (n=19). On the contrary, in group II, the main indication for surgery was type A acute dissection (45.2%, n=14), and 48.8% (n=15) of patients were operated on an urgent or emergent situation.
Regarding the technical modifications, in group II as compared to group I, brain protection was achieved under bilateral selective antegrade perfusion (100% vs 64%, p<0.001), distal anastomosis was moved to Z0-Z2 (100% vs 72%, p=0.02), core temperature was higher (25±2 vs 22±3, p<0.001), LSA was perfused during lower body circulatory arrest (87.1% vs 0%, p<0.001) and thoracoabdominal aorta perfusion was reestablished after distal anastomosis (96.8% vs 40%, p<0.001). These modifications resulted in a significant reduction of the lower body circulatory arrest time (33±1min vs 54±2min, p<0.001). Other modifications included arterial cannulation with graft interposition in almost any patient (96.8% vs 36%, p<0.001), innominate artery as our artery of choice for cannulation (48% vs 16%, p=0.01) and crystalloid Bretschneider´s solution for myocardial protection (96.8% vs 36%, p<0.001).
Hospital mortality was 7.1% (n=4) (Table 3). Causes of death were intraoperative hemorrhage, stroke, sepsis and respiratory failure.
Permanent stroke and spinal cord injury occurred in 3.6%(n=2) and 1.8%(n=1) respectively. Laryngeal nerve lesion occurred in 3.6% (n=2). Hospital mortality (12%, n=3 vs 3.2%, n=1; p=0.31), permanent stroke (3.6%, n=2 vs 0%, n=0; p=0.28), and laryngeal nerve lesion (8%, n=2 vs 0%, n=0; p=0.1) were less frequent in Group II (Table 3). Median ICU and hospital stay were 4 days (IQR 3-13 days) and 15 days (IQR 10-34 days), respectively, with no differences between Group I and II.