Early Results Of Total Thoracoabdominal Aortic Replacement By Segmental Occlusion Under Normothermic Autologous Arterial Bypass And Exploration Of Intraoperative Warming Strategies

Background:Thoracoabdominal aortic aneurysm(TAAA)is a life-threatening aortic disease.Conventional technique with deep hypothermia circulatory arrest(DHCA)during extensive TAAA repair often complicated with high mortality and complications.We evaluated the early results of arterial bypass with normothermia technique during repair of extensive TAAA.Methods:220 patients who underwent aortic replacement for the Crawford type Ⅱthoraco-abdominal aortic aneurysm between January 2005 and July 2019 were assigned to 2 groups:normothermic group(n=105)and deep hypothermic circulatory arrest group(n=115).We analysed early operative death,a composite of complications.Results:There were 6(5.7%)cases of early death in the normothermic group and 9(7.8)cases in DHCA group(7.8).There was no statistical difference between the two groups(p=0.535).The normothermic group was superior to the DHCA group in terms of re-exploration for haemorrhage,re-intubation,cerebral infarction and gastrointestinal dysfunction.(Re-exploration for haemorrhage:8.6%vs21.9%,p=0.016).Re-intubation:1%vs9.6%,p=0.012;Cerebral infarction:1%vs6.1%,p=0.04;Gastrointestinal dysfunction:1%vs10.5%,p=0.002).Conclusions:Normothermic iliac perfusion provides a viable alternative for thoraco-abdominal aortic aneurysm repair,which reduced composited complications.Background:To evaluate whether the heated humidified ventilation can effectively maintain core temperature and improve prognosis in normothermic thoraco-abdominal aortic aneurysm repair surgery.Methods:Patients who were scheduled for normothermic thoraco-abdominal aortic aneurysm repair surgery were randomized into the group using heated humidified ventilation combined with water blanket and the group using water blanket only.During the operation,the core temperature will be measured every 30 minutes.We analyzed intraoperative core-temperature,coagulation function and in-hospital mortality.Results:HHV&WB group showed lesser decrease in core temperature than WB groups in the first two hours,while WB group had a higher body temperature at the third to fifth hour(2hour:35.45±0.47℃vs35.24±0.59℃,p=0.284;5 hour:35.38±0.70vs 35.51±0.88,p=0.664).There was less blood loss,dosage of coagulation drugs and in-hospital mortality(13.33%vs20%,p=1)in the HHV&WB group.Conclusions:Heated humidified ventilation can improve the prognosis of normothermic thoraco-abdominal aortic aneurysm repair surgery to some extent,but it can only maintain the core temperature during the first two hours.