Stevan S Pupovac1, Jonathan M Hemli2, Joseph E Bavaria3, Himanshu J Patel4, Santi Trimarchi5, Davide Pacini6, Raffi Bekeredjian7, Edward P Chen8, Truls Myrmel9, Maral Ouzounian10, Christina Fanola11, Amit Korach12, Daniel G Montgomery4, Kim A Eagle4, Derek R Brinster2. 1. Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital / Northwell Health, Manhasset, NY, USA. Electronic address: spupovac@northwell.edu. 2. Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital / Northwell Health, New York, NY, USA. 3. Division of Cardiothoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. 4. Cardiovascular Center, University of Michigan Health System, Ann Arbor, MI, USA. 5. Department of Scienze Cliniche e di Comunita, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. 6. Department of Cardiac Surgery, University Hospital S. Orsola, Bologna, Italy. 7. Department of Cardiology, Robert-Bosch Krankenhaus, Stuttgart, Germany. 8. Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA. 9. Department of Thoracic & Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway. 10. Division of Cardiac Surgery, Toronto General Hospital, Toronto, Canada. 11. Cardiovascular Division, University of Minnesota Physicians Heart Practice, Minneapolis, MN, USA. 12. Department of Cardiothoracic Surgery, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Abstract
BACKGROUND: The optimal strategy for cerebral protection during repair of type A acute aortic dissection (TAAAD) has yet to be determined. We sought to determine the impact of differing degrees of hypothermia in patients undergoing acute dissection repair. METHODS: All patients in the International Registry of Acute Aortic Dissection Interventional Cohort (IRAD-IVC) database who underwent TAAAD repair between 2010 and 2018 were identified. Data for operative temperature was available in 1962 patients, subsequently divided into 2 groups according to lowest temperature: moderate hypothermic circulatory arrest (MHCA) (20 - 28°C) vs. deep hypothermic circulatory arrest (DHCA) (< 20°C). We then propensity-matched 362 pairs of patients and analyzed operative data and short-term outcomes. RESULTS: The median lowest temperature was 25.0°C in the matched MHCA group, as compared with 18.0°C in DHCA. For the entire cohort of 1962 patients, in-hospital mortality was 14.2% (278 deaths), not significantly different between DHCA and MHCA. Perioperative stroke rate was comparable between groups, before and after propensity-matching. Circulatory arrest times were significantly longer in the MHCA cohort, regardless of matching. Use of antegrade or retrograde cerebral perfusion was similar in matched groups. There were no differences in 30-day survival, or in other major postoperative morbidity between the two matched cohorts. CONCLUSIONS: A surgical strategy of MHCA + ACP is at least as safe as DHCA during repair of acute type A aortic dissection.
BACKGROUND: The optimal strategy for cerebral protection during repair of type A acute aortic dissection (TAAAD) has yet to be determined. We sought to determine the impact of differing degrees of hypothermia in patients undergoing acute dissection repair. METHODS: All patients in the International Registry of Acute Aortic Dissection Interventional Cohort (IRAD-IVC) database who underwent TAAAD repair between 2010 and 2018 were identified. Data for operative temperature was available in 1962 patients, subsequently divided into 2 groups according to lowest temperature: moderate hypothermic circulatory arrest (MHCA) (20 - 28°C) vs. deep hypothermic circulatory arrest (DHCA) (< 20°C). We then propensity-matched 362 pairs of patients and analyzed operative data and short-term outcomes. RESULTS: The median lowest temperature was 25.0°C in the matched MHCA group, as compared with 18.0°C in DHCA. For the entire cohort of 1962 patients, in-hospital mortality was 14.2% (278 deaths), not significantly different between DHCA and MHCA. Perioperative stroke rate was comparable between groups, before and after propensity-matching. Circulatory arrest times were significantly longer in the MHCA cohort, regardless of matching. Use of antegrade or retrograde cerebral perfusion was similar in matched groups. There were no differences in 30-day survival, or in other major postoperative morbidity between the two matched cohorts. CONCLUSIONS: A surgical strategy of MHCA + ACP is at least as safe as DHCA during repair of acute type A aortic dissection.