Norman Anthony V, Challa Sanjana, Lyons Genevieve, Wisniewski Alexander M, Strobel Raymond J, Mazzeffi Michael, Joseph Mark, Tang Daniel, Singh Ramesh, Kontos Michael C, Quader Mohammed, Yount Kenan, Teman Nicholas R, Preventza Ourania, Beller Jared P
Division of Cardiothoracic Surgery, University of Virginia, Charlottesville, Virginia.
Department of Public Health Sciences, University of Virginia, Charlottesville, Virginia.
Aorta (Stamford). 2025 Apr;13(2):56-64. doi: 10.1055/a-2693-4175. Epub 2025 Sep 17.
Deep hypothermic circulatory arrest (DHCA) is associated with coagulopathy but facilitates aortic arch surgery. Conflicting data suggest moderate hypothermic circulatory arrest (MHCA) may reduce transfusion requirements. We hypothesized MHCA would reduce transfusion requirements.We studied patients undergoing aortic hemiarch surgery for nondissected, aneurysmal disease from July 2014 to May 2023 utilizing a multicenter collaborative. Patients were stratified by DHCA (14.1-20°C) and MHCA (20.1-28°C). Packed red blood cells (pRBC), fresh frozen plasma (FFP), cryoprecipitate, and platelet transfusion requirements were assessed. A negative binomial model accounting for hospital random effect was fitted to identify risk factors for increased transfusion requirements.Of the 451 patients undergoing hemiarch surgery, 373 (83%) had MHCA and 78 (17%) had DHCA. MHCA patients had shorter cardiopulmonary bypass (135 minutes [105, 182] vs. 216 minutes [183, 263], < 0.001) and circulatory arrest times (12 minutes [8, 17] vs. 21 minutes [16, 34], < 0.001). MHCA patients received fewer pRBC (0 [0, 1] vs. 1 [0, 3], < 0.001), FFP (0 [0, 3] vs. 2 [0, 4], = 0.003), cryoprecipitate (1 [0, 1] vs. 1 [0, 2], = 0.045), and platelet transfusions (0 [0, 1] vs. 2 [0, 2], < 0.001). Unadjusted operative mortality was lower in the MHCA group (1.9 vs. 7.7%, < 0.01). After risk adjustment, MHCA was associated with reduced FFP transfusion requirements (β = -0.48, SE = 0.2, = 0.017). Increasing bypass time per minute was associated with increased pRBC (β = +0.01, 95% CI = 0.006-0.013, < 0.001), FFP (β = +0.006, 95% CI = 0.004-0.009, < 0.001), cryoprecipitate (β = +0.008, 95% CI = 0.005-0.01, < 0.001), and platelet transfusions (β = +0.009, 95% CI = 0.006-0.011, < 0.001).MHCA was associated with decreased mortality and FFP transfusions in aortic hemiarch repair. MHCA may mitigate transfusion needs via shorter cardiopulmonary bypass time compared with DHCA.
深度低温循环停搏（DHCA）与凝血病相关，但有助于主动脉弓手术。相互矛盾的数据表明，中度低温循环停搏（MHCA）可能会减少输血需求。我们假设MHCA会减少输血需求。我们利用多中心合作研究了2014年7月至2023年5月期间因非夹层动脉瘤性疾病接受主动脉半弓手术的患者。患者按DHCA（14.1 - 20°C）和MHCA（20.1 - 28°C）分层。评估了浓缩红细胞（pRBC）、新鲜冰冻血浆（FFP）、冷沉淀和血小板的输血需求。采用考虑医院随机效应的负二项式模型来确定输血需求增加的危险因素。
在451例接受半弓手术的患者中，373例（83%）采用MHCA，78例（17%）采用DHCA。MHCA患者的体外循环时间较短（135分钟[105, 182]对216分钟[183, 263]，<0.001），循环停搏时间也较短（12分钟[8, 17]对21分钟[16, 34]，<0.001）。MHCA患者接受的pRBC较少（0[0, 1]对1[0, 3]，<0.001）、FFP较少（0[0, 3]对2[0, 4]，=0.003）、冷沉淀较少（1[0, 1]对1[0, 2]，=0.045）以及血小板输注较少（0[0, 1]对2[0, 2]，<0.001）。未调整的手术死亡率在MHCA组较低（1.9%对7.7%，<0.01）。风险调整后，MHCA与FFP输血需求减少相关（β=-0.48，SE=0.2，=0.017）。每分钟体外循环时间增加与pRBC（β=+0.01，95%CI=0.006 - 0.013，<0.001）、FFP（β=+0.006，95%CI=0.004 - 0.009，<0.001）、冷沉淀（β=+0.008，95%CI=0.005 - 0.01，<0.001）和血小板输注（β=+0.009，95%CI=0.006 - 0.011，<0.001）增加相关。
MHCA与主动脉半弓修复术中死亡率降低和FFP输血减少相关。与DHCA相比，MHCA可能通过缩短体外循环时间来减轻输血需求。
