Table 2.
Intraoperative characteristics over the study period, 2008 to 2018
| Year | 2008(n = 148) | 2010(n = 267) | 2012(n = 310) | 2014(n = 584) | 2016(n = 753) | 2018(n = 373) | Modeled linear regression P value* |
|---|---|---|---|---|---|---|---|
| Aortic replacement | |||||||
| Ascending aorta | 111 (87) | 231 (87) | 274 (88) | 492 (84) | 648 (86) | 315 (84) | 0.92 |
| Arch replacement | |||||||
| Hemiarch replacement | 85 (66) | 177 (66) | 216 (70) | 446 (76) | 600 (80) | 290 (78) | 0.30 |
| Total arch replacement | 23 (18) | 44 (16) | 43 (14) | 76 (13) | 126 (17) | 75 (20) | 0.18 |
| Elephant trunk repair | 14 (9.5) | 24 (9.0) | 14 (4.5) | 41 (7.0) | 93 (12) | 70 (19) | < 0.001 |
| Frozen elephant trunk repair | 4 (3.1) | 9 (3.4) | 4 (1.3) | 11 (1.9) | 46 (6.1) | 56 (15) | < 0.001 |
| Aortic valve or root surgery | |||||||
| Aortic valve replacement | 17 (13) | 36 (13) | 47 (15) | 104 (18) | 128 (17) | 81 (22) | 0.08 |
| Bentall procedure | 35 (27) | 80 (30) | 90 (29) | 194 (33) | 208 (28) | 73 (20) | < 0.01 |
| Ross procedure | 0 (0) | 1 (0.37) | 5 (1.6) | 8 (1.4) | 16 (2.1) | 7 (1.9) | 0.03 |
| Valve-sparing root replacement | 0 (0) | 16 (6.0) | 24 (7.7) | 44 (7.5) | 72 (10) | 55 (15) | < 0.001 |
| Aortic valve repair | 27 (21) | 51 (19) | 61 (20) | 80 (14) | 113 (15) | 81 (22) | 0.88 |
| Concomitant surgery | |||||||
| Any concomitant surgery | 49 (38) | 92 (34) | 110 (35) | 207 (35) | 224 (30) | 125 (34) | 0.72 |
| Mitral valve replacement | 1 (0.78) | 7 (2.6) | 11 (3.5) | 11 (1.9) | 19 (2.5) | 3 (0.8) | 0.71 |
| Mitral valve repair | 2 (1.6) | 1 (0.37) | 3 (1.0) | 12 (2.1) | 12 (1.6) | 5 (1.3) | 0.25 |
| Coronary artery bypass grafting | 17 (13) | 52 (19) | 54 (17) | 120 (21) | 114 (15) | 64 (17) | 0.58 |
| ASD or VSD closure | 0 (0) | 1 (0.37) | 8 (2.6) | 14 (2.4) | 10 (1.3) | 4 (1.1) | 0.50 |
| Head or neck vessel surgery | 22 (17) | 42 (16) | 31 (10) | 65 (11) | 88 (12) | 53 (14) | 0.43 |
| Other | 16 (13) | 21 (7.9) | 29 (9.4) | 52 (8.9) | 62 (8.2) | 34 (9.1) | 0.28 |
| Perfusion, min | |||||||
| Cardiopulmonay bypass time | 173 [143, 221] | 192 [142, 245] | 187 [141, 237] | 180 [142, 230] | 178 [135, 230] | 176 [125, 224] | < 0.001 |
| Cross-clamp time | 92 [64, 129] | 107 [65, 144] | 107 [67, 154] | 120 [77, 161] | 114 [74, 165] | 111 [72, 165] | 0.36 |
| Hypothermic circulatory arrest time | 23 [15, 33] | 22 [16, 36] | 20 [15, 31] | 20 [14, 30] | 21 [14, 32] | 20 [16, 30] | < 0.001 |
| Hypothermic circulatory arrest time categories, min | < 0.001 | ||||||
| ≤ 30 | 90 (70) | 182 (68) | 227 (73) | 440 (75) | 552 (73) | 283 (76) | |
| 31–59 | 30 (23) | 54 (20) | 59 (19) | 104 (18) | 148 (20) | 65 (17) | |
| ≥ 60 | 8 (6.3) | 31 (12) | 24 (7.7) | 40 (6.8) | 53 (7.0) | 25 (6.7) | |
| Lowest temperature,°C | 18 [17, 21] | 19 [18, 23] | 22 [18, 25] | 24 [20, 26] | 25 [21, 26] | 25 [23, 28] | < 0.001 |
| Lowest temperature, ≥ 24°C | 14 (12) | 36 (16) | 110 (42) | 290 (55) | 447 (62) | 274 (74) | < 0.001 |
| Cerebral perfusion strategy | |||||||
| None | 49 (38) | 86 (32) | 80 (26) | 115 (20) | 96 (13) | 42 (11) | < 0.001 |
| Antegrade | 78 (61) | 181 (68) | 222 (72) | 431 (74) | 618 (82) | 309 (83) | < 0.001 |
| Retrograde | 1 (0.78) | 0 (0) | 8 (2.6) | 38 (6.5) | 39 (5.2) | 22 (5.9) | 0.70 |
| Cerebral perfusion time, min | 11 [0, 25] | 15 [0, 26] | 16 [0, 26] | 17 [9, 26] | 19 [11, 28] | 19 [13, 27] | < 0.01 |
| Cerebral ischemia time, min | 2 [0, 20] | 0 [0, 18] | 0 [0, 12] | 0 [0, 9] | 0 [0, 4] | 0 [0, 4] | < 0.001 |
| Cerebral ischemia time, ≥ 30 mins | 15 (12) | 29 (11) | 22 (7.1) | 21 (3.6) | 27 (3.6) | 9 (2.4) | < 0.001 |
| Transfusion | |||||||
| Any | 92 (72) | 194 (73) | 220 (71) | 365 (63) | 471 (63) | 204 (55) | < 0.001 |
| Any pRBC used | 67 (52) | 133 (50) | 153 (49) | 248 (42) | 340 (45) | 147 (39) | < 0.001 |
| Any FFP used | 74 (58) | 156 (58) | 178 (57) | 279 (48) | 362 (48) | 159 (43) | < 0.001 |
| Any platelet used | 76 (59) | 163 (61) | 180 (58) | 285 (49) | 358 (48) | 173 (46) | < 0.001 |
| Any factor VII used | 19 (15) | 36 (14) | 34 (11) | 38 (6.8) | 39 (5.2) | 18 (4.8) | < 0.001 |
Table shows trends in intraoperative characteristics and surgical techniques in 2435 patients who underwent aortic arch surgery with hypothermic circulatory arrest, between 2008 and 2018, in 12 institutions across Canada. Values are n (%) or median [interquartile range].
ASD, atrial septal defect; FFP, fresh frozen plasma; pRBC, packed red blood cell; VSD, ventricular septal defect.
⁎
Trend in time for binary, ordinal, categorical, or continuous variables was assessed using mixed-effect regression models using date of surgery as a continuous variable to assess a linear trend across the years from 2008 to 2018.