Burjeel Medical City, Abu Dhabi, United Arab Emirates.
Peshawar Institute of Cardiology, Peshawar, Pakistan.
Asian Cardiovasc Thorac Ann. 2022 Jul;30(6):635-644. doi: 10.1177/02184923211069186. Epub 2022 Jan 11.
Deep hypothermic circulatory arrest (DHCA) in aortic surgery is associated with morbidity and mortality despite evolving strategies. With the advent of antegrade cerebral perfusion (ACP), moderate hypothermic circulatory arrest (MHCA) was reported to have better outcomes than DHCA. There is no standardised guideline or consensus regarding the hypothermic strategies to be employed in open aortic surgery. Meta-analysis was performed comparing DHCA with MHCA + ACP in patients having aortic surgery.
A systematic review of the literature was undertaken. Any studies with DHCA versus MHCA + ACP in aortic surgeries were selected according to specific inclusion criteria and analysed to generate summative data. Statistical analysis was performed using STATS Direct. The primary outcomes were hospital mortality and post-operative stroke. Secondary outcomes were cardiopulmonary bypass time (CPB), post-operative blood transfusion, length of ICU stay, respiratory complications, renal failure and length of hospital stay. Subgroup analysis of primary outcomes for Arch surgery alone was also performed.
Fifteen studies were included with a total of 5869 patients. There was significantly reduced mortality (Pooled OR = +0.64, 95% CI = +0.49 to +0.83; = 0.0006) and stroke rate (Pooled OR = +0.62, 95% CI = +0.49 to +0.79; < 0.001) in the MHCA group. MHCA was associated significantly with shorter CPB times, shorter duration in ICU, less pulmonary complications, and reduced rates of sepsis. There was no statistical difference between the two groups in terms of circulatory arrest times, X-Clamp times, total operation duration, transfusion requirements, renal failure and post-op hospital stay.
MHCA + ACP are associated with significantly better post-operative outcomes compared with DHCA for both mortality and stroke and majority of the secondary outcomes.
尽管主动脉手术中的深低温停循环（DHCA）策略不断发展，但仍与发病率和死亡率相关。随着顺行性脑灌注（ACP）的出现，中低温停循环（MHCA）的报道显示其结果优于 DHCA。在开放主动脉手术中，尚无关于使用低温策略的标准化指南或共识。本研究对主动脉手术中 DHCA 与 MHCA+ACP 进行了比较的荟萃分析。
对文献进行系统评价。根据具体纳入标准选择 DHCA 与 MHCA+ACP 在主动脉手术中的研究，并进行分析以生成汇总数据。使用 STATS Direct 进行统计学分析。主要结局是医院死亡率和术后中风。次要结局是体外循环时间（CPB）、术后输血、重症监护病房住院时间、呼吸并发症、肾衰竭和住院时间。还对单独行弓部手术的主要结局进行了亚组分析。
共纳入 15 项研究，总计 5869 例患者。MHCA 组死亡率（合并 OR=0.64，95%CI=0.49 至 0.83；=0.0006）和中风发生率（合并 OR=0.62，95%CI=0.49 至 0.79；<0.001）显著降低。MHCA 与 CPB 时间更短、ICU 住院时间更短、肺部并发症更少以及败血症发生率降低相关。两组在循环阻断时间、X 夹钳闭时间、总手术时间、输血需求、肾衰竭和术后住院时间方面无统计学差异。
MHCA+ACP 与 DHCA 相比，无论是死亡率还是中风，以及大多数次要结局，术后结果都显著更好。
