Deep vs. Moderate Hypothermia in Acute Type A Aortic Dissection: A Propensity-Matched Analysis
Stevan S. Pupovac1, Jonathan M. Hamli, MD2, Ashley T. Giammarino, MS2, S Jacob Scheinerman, MD2, Alan R. Hartman, MD1, Derek R. Brinster, MD2.
1North Shore University Hospital / Northwell Health, Manhasset, NY, USA, 2Lenox Hill Hospital / Northwell Health, New York, NY, USA.
OBJECTIVE: The ideal temperature for hypothermic circulatory arrest (HCA) during acute type A aortic dissection (ATAAD) repair has yet to be determined. We examined the clinical impact of different degrees of hypothermia during dissection repair.
METHODS: Out of 237 cases of ATAAD between June 2014 and December 2019, 228 patients were divided into 2 groups according to lowest intraoperative temperature: moderate hypothermic circulatory arrest (MHCA) (20 - 28°C) vs. deep hypothermic circulatory arrest (DHCA) (< 20°C). From this, 106 pairs of propensity-matched patients were analyzed with respect to operative data and short-term clinical outcomes. Independent predictors of a composite outcome of 30-day mortality and stroke were identified.
RESULTS: Median lowest temperature was 28.0°C in the MHCA group vs. 17.0°C in DHCA. Overall 30-day mortality was 11.8% (27 deaths), significantly greater in DHCA (9.6%, 22 deaths vs. 2.2%, 5 deaths, p = 0.004). Cardiopulmonary bypass (CPB) times were longer in DHCA (223.40 ± 70.80 vs. 186.00 ± 74.40 minutes, p < 0.001). Antegrade cerebral perfusion (ACP) during HCA predicted a lower composite risk of 30-day mortality and stroke (HR 0.38). Female sex (HR 2.97), lower extremity ischemia at presentation (HR 3.36), and CPB > 235 minutes (HR 2.47), all portended worse postoperative outcomes (Table 1).
CONCLUSIONS: DHCA is associated with greater 30-day mortality after ATAAD repair than is MHCA. ACP during HCA is associated with reduced 30-day mortality and stroke, whereas female sex, lower extremity ischemia, and longer CPB times are all predictive of poorer short-term outcomes.
|Antegrade cerebral perfusion||0.38||0.17 - 0.85|
|Female sex||2.97||1.30 - 6.81|
|Lower extremity ischemia at clinical presentation||3.36||1.36 - 8.30|
|Cardiopulmonary bypass time >235 minutes||2.47||1.10 - 5.65|
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