Wakisaka Hodaka, Miwa Shunta, Matsubayashi Yuji, Mori Yotaro, Lee Junghun, Kamiya Kenichi, Takashima Noriyuki, Suzuki Tomoaki
Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.
Interdiscip Cardiovasc Thorac Surg. 2024 Oct 8;39(4). doi: 10.1093/icvts/ivae166.
Brain-protective strategies for acute type A aortic dissection (TAAD) remain controversial. Moderate hypothermia circulatory arrest (MHCA) without cerebral perfusion is not commonly used. However, we aimed to assess its safety and efficacy in 358 patients who underwent hemiarch replacement with MHCA for acute type A aortic dissection at our institution from August 2012 to August 2022.
Clinical outcomes were compared according to circulatory arrest time [≤15 min (S group, n = 52) vs ≥16 min (L group, n = 306)]. The primary outcome was postoperative stroke.
The S group had more older patients (72.5 vs 68.8 years; P = 0.04), a greater incidence of carotid artery malperfusion (21% vs 11%; P = 0.043) and a lower body mass index (21.7 vs 23.6 kg/m2; P < 0.01) and hemodynamic instability (3.8% vs 16%; P = 0.02) than the L group. The incidence of postoperative stroke (7.7% vs 12%; P = 0.33) and the rate of 30-day mortality (5.8% vs 6.5%; P = 0.83) did not significantly differ between groups. After adjusting for all potential confounding factors pre- and intraoperatively, there was no significant difference in postoperative outcomes between groups.
MHCA alone for TAAD had comparable postoperative outcomes with circulatory arrest times under and over 15 min. However, longer arrest times were associated with a higher risk of stroke.
急性A型主动脉夹层（TAAD）的脑保护策略仍存在争议。不进行脑灌注的中度低温循环骤停（MHCA）并不常用。然而，我们旨在评估2012年8月至2022年8月期间在本机构接受MHCA半弓置换术治疗急性A型主动脉夹层的358例患者中，该方法的安全性和有效性。
根据循环骤停时间[≤15分钟（S组，n = 52）与≥16分钟（L组，n = 306）]比较临床结果。主要结局是术后中风。
与L组相比，S组老年患者更多（72.5岁对68.8岁；P = 0.04），颈动脉灌注不良发生率更高（21%对11%；P = 0.043），体重指数更低（21.7对23.6kg/m²；P < 0.01），血流动力学不稳定发生率更低（3.8%对16%；P = 0.02）。两组术后中风发生率（7.7%对12%；P = 0.33）和30天死亡率（5.8%对6.5%；P = 0.83）无显著差异。在对术前和术中所有潜在混杂因素进行调整后，两组术后结局无显著差异。
单独使用MHCA治疗TAAD，循环骤停时间在15分钟及以内和超过15分钟的术后结局相当。然而，更长的骤停时间与更高的中风风险相关。
