Abdominal Organ Dysfunction after Open Aortic Arch Surgery using Different Cerebral Protection Strategies

Saddam MA Al-Sabri, Anselm Bräuer, Jose Hinz, Marius Grossman, Michael Quintel, Bernard C Danner, Onnen Moerer, Friedrich A Schöndube and Terézia B Andrási,

Department of Thoracic, Cardiac and Vascular Surgery, University of Göttingen, Germany
Department of Anesthesiology, University of Göttingen, Germany
Department of Cardiovascular Surgery, University of Marburg, Germany

^*Correspondance to: Ter�zia B Andr�si 

 PDF  Full Text DOI: 10.25107/2474-1647.2371

Abstract

Background: A positive impact of Antegrade Cerebral Perfusion (ACP) on neurological function and survival in patients undergoing open aortic arch surgery under Deep Hypothermic Circulatory Arrest (DHCA) has been emphasized but the suggested secondary remote protective effects of ACP on the abdominal organ function through collateral perfusion remains controversial.
Methods: Markers of visceral function were retrospectively analyzed in adults with acquired aortic arch disease who underwent DHCA (n=37) or ACP (70) for open surgical aortic arch replacement at one institution.
Results: Preoperative characteristics (ascending aortic dissection: 78.4% vs. 71.4%, p=0.436; abdominal extension: 29.1% vs. 31.4%, p=0.857; hemodynamic instability: 8.1% vs. 10.0%, p=0.749), intraoperative data and complications were similar. Preoperative lactate, postoperative inotropic support and maximal postoperative ALT, CK and lactate levels were significantly higher in nonsurvivors vs. survivors (p<0.05) in both ACP and DHCA groups. Maximal postoperative CK and lactate correlated with the preoperative lactate values (p<0.05 and p<0.01) whereas ALT and lactate correlated with postoperative inotropic index (p<0.05, p<0.0001) in both groups. Although maximal postoperative ALT and CK differed in the univariate analysis (p<0.05), they failed to demonstrate an independent predictor capacity for death. Multivariate analysis revealed an association between mortality and preoperative hemodynamic instability (HR=3.69, p=0.023), maximal postoperative lactate (HR=1.02, p=0.0001) and maximal postoperative inotropic score (HR=1.00, p=0.006).
Conclusion: ACP did not influence postoperative abdominal biomarkers; thus, a direct protective effect through improved arterial collateral circulation remains implausible. Hemodynamic instability and cardio-circulatory failure rather than visceral dysfunction seem responsible for mortality after open surgical aortic arch replacement.

Keywords

Deep hypothermic circulatory arrest; Antegrade cerebral perfusion; Visceral malperfusion; Abdominal biomarkers

Cite the article

Al-Sabri SMA, Br�uer A, Hinz J, Grossman M, Quintel M, Danner BC, et al. Abdominal Organ Dysfunction after Open Aortic Arch Surgery using Different Cerebral Protection Strategies. Clin Surg. 2019; 4: 2371.