Reoperation of the proximal aorta: Impact of presternotomy extracorporeal circulation on clinical outcomes

Purpose: Adverse events can occur during a sternotomy for reoperation of the proximal aorta. Presternotomy extracorporeal circulation is often employed to avoid catastrophic events. The purpose of this study was to investigate the impact of presternotomy extracorporeal circulation on clinical outcomes of redo proximal aortic surgery. Methods: Between January1990 and December 2005 a total of 21 aneurysms or dissections of the proximal aorta were repaired via a repeat sternotomy. Extracorporeal circulation was established before the sternotomy in 9 (49%) patients and after the sternotomy in 12 (51%) patients. Results: There were no statistically significant differences in the age, sex, emergency surgery, chronic obstructive pulmonary disease, and renal function between the groups. Femoral cannulation was used more often in the presternotomy extracorporeal circulation group (8/9, 89% vs. 1/12, 8.3%; P = 0.000). The difference in the pump time did not reach a statistically significant level. The 30-day and in-hospital mortality rates were 11% (1/9) and 11% (1/9) in the presternotomy extracorporeal circulation group and 0% (0/12) and 17% (2/12) in the poststernotomy extracorporeal circulation group. There were no statistically significant differences in stroke, respiratory failure, myocardial infarction, or renal failure. There was a trend toward a longer hospital stay in the presternotomy extracorporeal circulation group (85.8 vs. 48.1 days; P = 0.06). Conclusion: Presternotomy extracorporeal circulation was not associated with any major adverse outcomes such as death, stroke, or renal failure.