Pupovac Stevan S, Hemli Jonathan M, Giammarino Ashley T, Varrone Michael, Aminov Areil, Scheinerman S Jacob, Hartman Alan R, Brinster Derek R
Department of Cardiothoracic Surgery, North Shore University Hospital/Northwell Health, Manhasset, NY, USA.
Department of Cardiovascular and Thoracic Surgery, Lenox Hill Hospital/Northwell Health, New York, NY, USA.
Heart Lung Circ. 2022 Dec;31(12):1699-1705. doi: 10.1016/j.hlc.2022.07.021. Epub 2022 Sep 21.
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.
Out of 240 cases of ATAAD between June 2014 and December 2019, 228 patients were divided into two groups according to lowest intraoperative temperature: moderate hypothermic circulatory arrest (MHCA) (20-28°C) versus deep hypothermic circulatory arrest (DHCA) (<20°C). From this, 74 pairs of propensity-matched patients were analysed with respect to operative data and short-term clinical outcomes. Independent predictors of a composite outcome of 30-day mortality and stroke were identified.
Mean lowest temperature was 25.5±3.9°C in the MHCA group versus 16.0±2.9°C in DHCA. Overall 30-day mortality of matched cohort was 11.5% (17 deaths), there were no significant different between matched groups. Cardiopulmonary bypass (CPB) times were longer in DHCA (221.0±69.9 vs 190.7±74.5 mins, p=0.01). Antegrade cerebral perfusion (ACP) during HCA predicted a lower composite risk of 30-day mortality and stroke (OR 0.38). Female sex (OR 4.71), lower extremity ischaemia at presentation (OR 3.07), and CPB >235 minutes (OR 2.47), all portended worse postoperative outcomes.
A surgical strategy of MHCA is at least as safe as DHCA during repair of acute type A aortic dissection. ACP during HCA is associated with reduced 30-day mortality and stroke, whereas female sex, lower extremity ischaemia, and longer CPB times are all predictive of poorer short-term outcomes.
在急性A型主动脉夹层（ATAAD）修复过程中，低温循环停止（HCA）的理想温度尚未确定。我们研究了夹层修复过程中不同程度低温的临床影响。
在2014年6月至2019年12月期间的240例ATAAD病例中，228例患者根据术中最低温度分为两组：中度低温循环停止（MHCA）（20-28°C）与深度低温循环停止（DHCA）（<20°C）。据此，对74对倾向匹配的患者进行了手术数据和短期临床结果分析。确定了30天死亡率和中风综合结果的独立预测因素。
MHCA组的平均最低温度为25.5±3.9°C，而DHCA组为16.0±2.9°C。匹配队列的总体30天死亡率为11.5%（17例死亡），匹配组之间无显著差异。DHCA的体外循环（CPB）时间更长（221.0±69.9对190.7±74.5分钟，p=0.01）。HCA期间的顺行性脑灌注（ACP）预测30天死亡率和中风的综合风险较低（OR 0.38）。女性（OR 4.71）、就诊时下肢缺血（OR 3.07）和CPB>235分钟（OR 2.47），均预示术后结果较差。
在急性A型主动脉夹层修复过程中，MHCA的手术策略至少与DHCA一样安全。HCA期间的ACP与30天死亡率和中风的降低相关，而女性、下肢缺血和更长的CPB时间均预示短期结果较差。
