Retrospective Analysis of Outcome of Aortic Aneurysm Surgery after change of Management and Monitoring Techniques

Aortic aneurysm surgery is a complex procedure associated with high risk of morbidity and mortality either intra-operatively or post-operatively. The aim of this study was to evaluate the outcome of aortic arch aneurysm surgery after modification in cannulation and monitoring techniques used during cardiopulmonary bypass (CPB).

Authors conducted a single centre retrospective analysis to compare the past cannulation, monitoring and CPB management techniques with current techniques in two groups of patients undergoing aortic aneurysm surgery. Clinical data was obtained between January 2002 to 2006 (group A; n=77) & from (2007–2011 group B; n=120). In group A, patients received direct percutaneous femoral cannulation for arterial return and retrograde cerebral perfusion (RCP) through superior vena cava (SVC) at 20*C for cerebral protection only, whereas group B, patients received axillary artery and femoral artery cannulation for arterial return, selective antegrade cerebral perfusion (SACP) along with near infrared spectroscopy (NIRS) monitoring for cerebral saturation, and in-line blood gas monitor was used for blood gas analysis. Authors analyzed the outcome of neurological morbidity, major adverse CPB related events, ICU stays and mortality rates.

Overall complications in group A (22%) was found to be higher than group B (10.8%). The group A (15.6%) patient had higher rate of neurological complications like brain death, stroke, and seizures. In group B (5.8%) patients had minor neurological injury as well as reduced general complication out of 120 (5.0%) vs 5 out of 77 (6.5%) like bleeding, multi organ failure, and sepsis. Overall decrease in group B mortality and improved outcome in comparison to group A, despite group B patient had undergone more complex procedures.

These finding demonstrate that current techniques of axillary artery cannulation, SACP, NIRS monitoring reduce mortality and morbidity. We also found that SACP is more beneficial than RCP in terms of cerebral protection techniques used in group B, can improve the outcome in complex aortic aneurysm surgery.