Original articleClinical Predictors for Prolonged Intensive Care Unit Stay in Adults Undergoing Thoracic Aortic Surgery Requiring Deep Hypothermic Circulatory Arrest
Section snippets
Methods
After obtaining institutional review board approval, all adults undergoing DHCA-TAS in 2000 and 2001 at the Hospital of the University of Pennsylvania were included in the study. The medical records were abstracted in a standardized fashion. The patient data were entered in predefined data fields (Microsoft Access; Microsoft, Seattle, WA) by trained study personnel. Each abstracted patient data set was subsequently reviewed by the study investigators, including a neurologist, who are all very
Results
The preoperative cohort summary is presented in Table 1. The average age was 64.7 years. There was no significant difference in sex. Antifibrinolytic exposure was 100%: 65.9% aprotinin and 34.1% aminocaproic acid. Both antifibrinolytic groups were similar (p > 0.05) except for emergency cases (aprotinin 24.5%, aminocaproic acid 3.6%, p < 0.05) and reoperation cases (arotinin 13.6%, aminocaproic acid 1.8%, p < 0.05).
The breakdown of surgical procedures is summarized in Table 2, Table 3.
Discussion
This clinical trial has examined a large adult DHCA-TAS cohort to characterize PLOS-ICU with respect to incidence and clinical predictors. The incidence of PLOS-ICU, as defined, is 27.8%. The first question is whether the definition of PLOS-ICU is too strict for DHCA-TAS, a very extensive cardiovascular procedure. This question is relevant but difficult to answer at this point because the current literature is focused on mortality and stroke and not on length of stay in the ICU for DHCA-TAS.26,
Conclusion
Prolonged ICU stay after DHCA-TAS is still common and is mostly related to perioperative injury to the brain, cardiovascular system, and kidney. Further evidence-based research is required to define robust perioperative predictors for these organ-based injuries so that hypothesis-driven perioperative interventions may be tested to improve perioperative patient outcome.
References (50)
- et al.
Temporary neurological dysfunction after deep hypothermic circulatory arrestA clinical marker for long-term functional deficit
Ann Thorac Surg
(1999) - et al.
Determination of cerebral blood flow dynamics during retrograde cerebral perfusion using power M-mode transcranial Doppler
Ann Thorac Surg
(2003) - et al.
Advances in the treatment of acute type A dissectionAn integrated approach
Ann Thorac Surg
(2002) - et al.
Deep hypothermic circulatory arrestEffects of cooling on the electroencephalogram and evoked potentials
Ann Thorac Surg
(2001) - et al.
Deep hypothermic circulatory arrestchanges in the electroencephalogram and evoked potentials during rewarming
Ann Thorac Surg
(2001) - et al.
Cerebral oxygenation during retrograde cerebral perfusion
Ann Thorac Surg
(1995) - et al.
Neurophysiologic effects of retrograde cerebral perfusion used for aortic reconstruction
J Cardiothorac Vasc Anesth
(1998) - et al.
Retrograde cerebral and distal aortic perfusion during ascending and thoracoabdominal aortic operations
Ann Thorac Surg
(1995) - et al.
Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusionNo relation of early death, stroke, and delirium to the duration of circulatory arrest
J Thorac Cardiovasc Surg
(1998) - et al.
Is extended arch replacement for acute type A dissection an additional risk factor for mortality?
Ann Thorac Surg
(2003)