TY - JOUR
T1 - Moderate hypothermia during aortic arch surgery is associated with reduced risk of early mortality
AU - Tsai, January Y.
AU - Pan, Wei
AU - Lemaire, Scott A.
AU - Pisklak, Paul
AU - Lee, Vei Vei
AU - Bracey, Arthur W.
AU - Elayda, Macarthur A.
AU - Preventza, Ourania
AU - Price, Matt D.
AU - Collard, Charles D.
AU - Coselli, Joseph S.
PY - 2013/9
Y1 - 2013/9
N2 - Objective: Selective antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) provides cerebral protection during aortic arch surgery. However, the ideal temperature for HCA during ACP remains unknown. Clinical outcomes were compared in patients who underwent moderate (nasopharyngeal temperature, ≥20 C) versus deep (nasopharyngeal temperature, <20 C) HCA with ACP during aortic arch repair. Methods: By using a prospectively maintained clinical database, we analyzed data from 221 consecutive patients who underwent aortic arch replacement with HCA and ACP between December 2006 and May 2009. Seventy-eight patients underwent deep hypothermia (mean lowest temperature, 16.8 C ± 1.7 C) and 143 patients underwent moderate hypothermia (mean, 22.9 C ± 1.4 C) before systemic circulatory arrest was initiated. Multivariate stepwise logistic and linear regressions were performed to determine whether depth of hypothermia independently predicted postoperative outcomes and blood-product use. Results: Compared with moderate hypothermia, deep hypothermia was associated independently with a greater risk of in-hospital death (7.7% vs 0.7%; odds ratio [OR], 9.3; 95% confidence interval [CI], 1.1-81.6; P =.005) and 30-day all-cause mortality (9.0% vs 2.1%; OR, 4.7; 95% CI, 1.2-18.6; P =.02), and with longer cardiopulmonary bypass time (154 ± 62 vs 140 ± 46 min; P =.008). Deep hypothermia also was associated with a higher incidence of stroke, although this association was not statistically significant (7.6% vs 2.8%; P =.073; OR, 4.3; 95% CI, 0.9-12.5). No difference was seen in acute kidney injury, blood product transfusion, or need for surgical re-exploration. Conclusions: Moderate hypothermia with ACP is associated with lower in-hospital and 30-day mortality, shorter cardiopulmonary bypass time, and fewer neurologic sequelae than deep hypothermia in patients who undergo aortic arch surgery with ACP.
AB - Objective: Selective antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) provides cerebral protection during aortic arch surgery. However, the ideal temperature for HCA during ACP remains unknown. Clinical outcomes were compared in patients who underwent moderate (nasopharyngeal temperature, ≥20 C) versus deep (nasopharyngeal temperature, <20 C) HCA with ACP during aortic arch repair. Methods: By using a prospectively maintained clinical database, we analyzed data from 221 consecutive patients who underwent aortic arch replacement with HCA and ACP between December 2006 and May 2009. Seventy-eight patients underwent deep hypothermia (mean lowest temperature, 16.8 C ± 1.7 C) and 143 patients underwent moderate hypothermia (mean, 22.9 C ± 1.4 C) before systemic circulatory arrest was initiated. Multivariate stepwise logistic and linear regressions were performed to determine whether depth of hypothermia independently predicted postoperative outcomes and blood-product use. Results: Compared with moderate hypothermia, deep hypothermia was associated independently with a greater risk of in-hospital death (7.7% vs 0.7%; odds ratio [OR], 9.3; 95% confidence interval [CI], 1.1-81.6; P =.005) and 30-day all-cause mortality (9.0% vs 2.1%; OR, 4.7; 95% CI, 1.2-18.6; P =.02), and with longer cardiopulmonary bypass time (154 ± 62 vs 140 ± 46 min; P =.008). Deep hypothermia also was associated with a higher incidence of stroke, although this association was not statistically significant (7.6% vs 2.8%; P =.073; OR, 4.3; 95% CI, 0.9-12.5). No difference was seen in acute kidney injury, blood product transfusion, or need for surgical re-exploration. Conclusions: Moderate hypothermia with ACP is associated with lower in-hospital and 30-day mortality, shorter cardiopulmonary bypass time, and fewer neurologic sequelae than deep hypothermia in patients who undergo aortic arch surgery with ACP.
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U2 - 10.1016/j.jtcvs.2013.03.004
DO - 10.1016/j.jtcvs.2013.03.004
M3 - Article
C2 - 23558304
AN - SCOPUS:84881613866
SN - 0022-5223
VL - 146
SP - 662
EP - 667
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
IS - 3
ER -