Department of Cardiovascular & Thoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, New York.
Department of Cardiovascular & Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, New York.
Ann Thorac Surg. 2021 Dec;112(6):1893-1899. doi: 10.1016/j.athoracsur.2021.01.027. Epub 2021 Jan 28.
The optimal strategy for cerebral protection during repair of type A acute aortic dissection has yet to be determined. We sought to determine the impact of differing degrees of hypothermia in patients undergoing acute dissection repair.
All patients in the International Registry of Acute Aortic Dissection Interventional Cohort database who underwent type A acute aortic dissection repair between 2010 and 2018 were identified. Data for operative temperature were available for 1962 patients subsequently divided into 2 groups according to lowest temperature: moderate hypothermic circulatory arrest (MHCA) (20-28°C) versus deep hypothermic circulatory arrest (DHCA) (<20°C). We then propensity matched 362 pairs of patients and analyzed operative data and short-term outcomes.
The median lowest temperature was 25.0°C in the matched MHCA group as compared with 18.0°C in the DHCA group. For the entire cohort of 1962 patients, in-hospital mortality was 14.2% (278 deaths) but was not significantly different between DHCA and MHCA. The 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 2 matched cohorts.
A surgical strategy of MHCA + antegrade cerebral perfusion is at least as safe as DHCA during repair of acute type A aortic dissection.
在修复急性 A 型主动脉夹层期间，脑保护的最佳策略尚未确定。我们旨在确定在接受急性夹层修复的患者中不同程度低温的影响。
在 2010 年至 2018 年期间，国际急性主动脉夹层介入队列登记处数据库中所有接受急性 A 型主动脉夹层修复的患者均被识别。可获得 1962 例患者的手术温度数据，随后根据最低温度将其分为 2 组：中度低温体外循环停搏（MHCA）（20-28°C）与深低温体外循环停搏（DHCA）（<20°C）。然后，我们对 362 对患者进行了倾向评分匹配，并分析了手术数据和短期结果。
与 DHCA 组的 18.0°C 相比，匹配的 MHCA 组的中位数最低温度为 25.0°C。在 1962 例患者的整个队列中，院内死亡率为 14.2%（278 例死亡），但在 DHCA 和 MHCA 之间无显著差异。在倾向评分匹配之前和之后，两组的围手术期卒中发生率相似。无论是否匹配，MHCA 组的体外循环时间明显更长。顺行或逆行脑灌注的使用在匹配组中相似。在 2 个匹配队列中，30 天生存率或其他主要术后发病率无差异。
在修复急性 A 型主动脉夹层期间，MHCA+顺行脑灌注的手术策略与 DHCA 一样安全。
