Incidence and clinical impact of silent pancreatitis after aortic arch surgery

• Published in: Asian cardiovascular & thoracic annals Vol. 31; no. 4; pp. 303 - 311
• Main Authors: Ohno, Tsukasa, Mutsuga, Masato, Saito, Shunei, Tokuda, Yoshiyuki, Nagai, Keiichi, Umemoto, Norio, Abe, Tomonobu, Usui, Akihiko
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.05.2023
• Subjects: Acute Disease; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - surgery; Cerebrovascular Circulation; Circulatory Arrest, Deep Hypothermia Induced - adverse effects; Humans; Incidence; Pancreatitis - epidemiology; Pancreatitis - etiology; Perfusion - adverse effects; Retrospective Studies; Risk Factors; Treatment Outcome; circulatory arrest; hypothermia; pancreas; ischemia
• ISSN: 0218-4923; 1816-5370
• DOI: 10.1177/02184923231158581

Background This study was designed to investigate the incidence and types of pancreatic injury, risk factors, and time-course changes in computed tomographic findings following total aortic arch replacement with moderate hypothermic circulatory arrest. Methods Medical records of patients who underwent total arch replacement between January 2006 and August 2021 were retrospectively reviewed. A comparison study between the patients with (group P) and without pancreatic injury (group N) was conducted to elucidate the impact of pancreatic injury. Follow-up computed tomography of the patients in group P was reviewed to investigate time-course changes of the pancreatic injury. Results Of 353 patients, 14 (4.0%) had subclinical pancreatic injury. Computed tomographic findings were consistent with acute pancreatitis in all patients, of whom eight patients had interstitial edematous pancreatitis, whereas six patients had necrotizing pancreatitis. Although walled-off necrosis occurred in three patients, none of them required drainage. In-hospital mortality was 7.1% and 4.4% in groups P and N, respectively (p  =  0.98). The 5-year actuarial survival rates were 77.9% and 81.0% in groups P and N, respectively (p  =  0.51). Multivariate analysis revealed that pancreatic injury was associated with chronic obstructive pulmonary disease (p  =  0.03). Conclusions This study highlighted that silent pancreatic injury after aortic arch surgery is underrecognized. Potential arterial sclerosis of the pancreatic circulation seems to be related to pancreatic injury.