Recent thoraco-abdominal aortic repair outcomes using moderate-to-deep hypothermia combined with targeted reconstruction of the Adamkiewicz artery†.

OBJECTIVES

We retrospectively reviewed the surgical results of thoraco-abdominal aortic repair using moderate-to-deep hypothermia combined with targeted reconstruction of the Adamkiewicz artery (AKA).

METHODS

Between 2006 and 2014, 100 patients underwent thoraco-abdominal aortic aneurysm repair using moderate-to-deep hypothermia. Their mean age was 58 ± 15 years and 76 (76%) were men. Their aortic pathologies included acute dissection (5), chronic dissection (74), degeneration (20) and infection (1). Thirty-four had connective tissue disorders and 5 had emergency operations. The degrees of repair were Crawford extent I for 11, II for 76 and III for 13. Seven had concomitant arch repair. Preoperative magnetic resonance angiography or computed tomographic angiography was performed to detect the AKA in 95. We used deep hypothermia (18 °C) for those requiring open proximal aortic anastomosis for cerebral protection and moderate hypothermia (25 °C) for those not requiring open proximal aortic anastomosis.

RESULTS

Two patients had spinal cord injuries and 4 had a stroke. For those in whom the AKA was identified (90%), all had targeted artery reconstruction. The mean pairs of reconstructed intercostal arteries were 1.5 ± 0.7. There were 5 in-hospital deaths for which the causes were lung bleeding (2), infection (2) and iliac aneurysm rupture (1). Temporary dialysis for new-onset renal failure was required for 9. The mean postoperative mechanical ventilation period was 1.7 ± 1.9 days. Six required a tracheostomy due to respiratory failure.

CONCLUSIONS

Moderate-to-deep hypothermia combined with targeted reconstruction of the AKA provided satisfactory outcomes with thoraco-abdominal aortic repair, particularly for spinal cord protection.