Khaled D Algarni1, Bobby Yanagawa2, Vivek Rao2, Terrence M Yau3. 1. King Saud University, Riyadh, Saudi Arabia; Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. 2. Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. 3. Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada. Electronic address: khaled.algarni@utoronto.ca.
Abstract
OBJECTIVE: To determine the impact of the degree of hypothermia on surgical outcomes in patients undergoing repair of acute type A aortic dissection. METHODS: Between 1990 and 2010, 211 consecutive patients underwent surgical repair of type A aortic syndrome. Patients with acute type A dissection (n = 128) were included. Circulatory arrest with profound hypothermia (PH; <20 °C) was used in 75 patients (58.6%) and circulatory arrest with moderate hypothermia (MH; 22-28 °C) in 53 patients (41.4%). Subacute or chronic dissections, intramural hematoma and penetrating aortic ulcers were excluded. RESULTS: Preoperative acute kidney injury was higher in the PH group (18.9% vs 5.3%, P = .01). Axillary or direct aortic cannulation was more prevalent in the MH group (33.9% vs 11.1%, P = .01). The duration of circulatory arrest was 25.9 ± 14.3 and 28.9 ± 19.9 minutes in the MH and PH groups, respectively (P = .3). The composite outcome of mortality, low cardiac output syndrome or stroke was higher in the PH group (52.8% vs 24%, P < .001). Cardiopulmonary bypass time and blood transfusion were significantly higher in the PH group (P = .04). By multivariable analysis (C = 0.80), PH (odds ratio [OR], 7.6; 95% confidence interval [CI], 3.0-21.1) and preoperative shock (OR, 3.5; 95% CI, 1.3-10.1) were independent predictors of the composite outcome. CONCLUSIONS: MH was independently associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of acute type A dissection. Use of moderate hypothermic circulatory arrest avoids the detrimental effects of PH without an increase in the risk of neurologic injury in this study.
OBJECTIVE: To determine the impact of the degree of hypothermia on surgical outcomes in patients undergoing repair of acute type A aortic dissection. METHODS: Between 1990 and 2010, 211 consecutive patients underwent surgical repair of type A aortic syndrome. Patients with acute type A dissection (n = 128) were included. Circulatory arrest with profound hypothermia (PH; <20 °C) was used in 75 patients (58.6%) and circulatory arrest with moderate hypothermia (MH; 22-28 °C) in 53 patients (41.4%). Subacute or chronic dissections, intramural hematoma and penetrating aortic ulcers were excluded. RESULTS: Preoperative acute kidney injury was higher in the PH group (18.9% vs 5.3%, P = .01). Axillary or direct aortic cannulation was more prevalent in the MH group (33.9% vs 11.1%, P = .01). The duration of circulatory arrest was 25.9 ± 14.3 and 28.9 ± 19.9 minutes in the MH and PH groups, respectively (P = .3). The composite outcome of mortality, low cardiac output syndrome or stroke was higher in the PH group (52.8% vs 24%, P < .001). Cardiopulmonary bypass time and blood transfusion were significantly higher in the PH group (P = .04). By multivariable analysis (C = 0.80), PH (odds ratio [OR], 7.6; 95% confidence interval [CI], 3.0-21.1) and preoperative shock (OR, 3.5; 95% CI, 1.3-10.1) were independent predictors of the composite outcome. CONCLUSIONS:MH was independently associated with a lower risk of a composite outcome of mortality and major adverse cardiac and cerebrovascular events during repair of acute type A dissection. Use of moderate hypothermic circulatory arrest avoids the detrimental effects of PH without an increase in the risk of neurologic injury in this study.
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