Rb Griepp

Neuropsychologic outcome after deep hypothermic circulatory arrest in adults

INTRODUCTION Pediatric patients undergoing prolonged periods of deep hypothermic circulatory arrest have been found to experience long-term deficits in cognitive function. However, there is limited information of this type in adult patients who are undergoing deep hypothermic circulatory arrest for thoracic aortic repairs. METHODS One hundred forty-nine patients undergoing elective cardiac or thoracic aortic operations were evaluated preoperatively; 106 patients were evaluated early in the postoperative period (EARLY), and 77 patients were evaluated late in the postoperative period (LATE) with a battery of neuropsychologic tests. Seventy-three patients had routine cardiac operations without deep hypothermic circulatory arrest, and 76 patients with deep hypothermic circulatory arrest were divided into 2 subgroups: those with 1 to 24 minutes of deep hypothermic circulatory arrest (n = 36 patients) and those with 25 minutes or more of deep hypothermic circulatory arrest (n = 40 patients). The neuropsychologic test battery consisted of 8 tests encompassing 5 domains: attention, processing speed, memory, executive function, and fine motor function. Data were normalized to baseline values, and changes from baseline were analyzed by analysis of covariance, multivariate logistic regression, and survival functions. RESULTS In all domains, poor performance or inability to be tested EARLY were significant predictors of poor performance LATE (odds ratio, 5.27; P <.01). Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were significant predictors of poor performance LATE for the memory and fine motor domains. Deep hypothermic circulatory arrest of 25 minutes or more (odds ratio, 4. 0; P =.02) was a determinant of prolonged hospital stay (>21 days). CONCLUSION Deep hypothermic circulatory arrest of 25 minutes or more and advanced age were associated with memory and fine motor deficits and with prolonged hospital stay.

Planned Staged Repair of Thoracoabdominal Aortic Aneurysms to Minimize Spinal Cord Injury: A Proof of Concept

Management of thoracoabdominal aortic aneurysms (TAA) can lead to spinal cord injury. A variety of clinical adjuncts have proven to decrease the incidence of paraplegia; however, at least 10% patients remain at risk of developing paraplegia. Experimentally and in sporadic clinical experiences, the staged repair of TAAs can lead to better neurologic outcomes. We present two clinical cases with extensive TAA in which a deliberate staged repair leads to excellent neurologic outcomes.Management of thoracoabdominal aortic aneurysms (TAA) can lead to spinal cord injury. A variety of clinical adjuncts have proven to decrease the incidence of paraplegia; however, at least 10% patients remain at risk of developing paraplegia. Experimentally and in sporadic clinical experiences, the staged repair of TAAs can lead to better neurologic outcomes. We present two clinical cases with extensive TAA in which a deliberate staged repair leads to excellent neurologic outcomes.

Reconstruction of the Aortic Arch for Aneurysm

Aneurysms of the aortic arch represent a formidable therapeutic challenge to the surgeon. Only within the last decade has it been possible to operate successfully on patients with these formerly lethal lesions.