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. 2022 Oct 19:16:1-7.
doi: 10.1016/j.xjtc.2022.09.020. eCollection 2022 Dec.

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair

Holly N Smith  1 , Akiko Tanaka  1 , Max Chehadi  1 , Harleen K Sandhu  1 , Charles C Miller 3rd  1 , Hazim J Safi  1 , Anthony L Estrera  1
Affiliations

Rapid cooling is a safe technique in patients undergoing circulatory arrest for aortic repair

Holly N Smith et al. JTCVS Tech. .

Abstract

Objective: To evaluate our institutional experience with rapid cooling for hypothermic circulatory arrest in proximal aortic repair.

Methods: We retrospectively reviewed data from 2171 patients who underwent proximal aortic surgery requiring hypothermic circulatory arrest between 1991 and 2020. Cooling times were divided into quartiles and clinical outcome event rates were compared across quartiles using contingency table methods. Incremental effect of cooling time was assessed in the context of other perfusion time variables using multiple logistic regression analysis.

Results: Median age was 61 years (interquartile range, 49-70 years) and 34.1% of patients were women. The procedure was emergent in 33.5% of patients, 22.9% had a previous sternotomy. The median circulatory arrest time was 22 minutes, with retrograde cerebral perfusion used in 94% of cases. Median cardiopulmonary bypass time was 149 minutes, with an aortic crossclamp time of 90 minutes. Patients were cooled to deep hypothermia. The first quartile had cooling times ranging from 5 to 13 minutes, second 14 to 18 minutes, third 19-23 minutes, and fourth 24-81 minutes. Overall, 30-day mortality was 9.4%, and was not significantly different across quartiles. There was a statistically significant trend toward lower rates of postoperative encephalopathy, gastrointestinal complications, and respiratory failure with shorter cooling times (P < .001, .006, and < .001, respectively). There was no significant difference in rates of postoperative stroke or dialysis.

Conclusions: Rapid cooling can be performed safely in patients undergoing aortic surgery requiring circulatory arrest without increasing mortality or stroke. There were significantly lower rates of coagulopathy, respiratory failure, and postoperative encephalopathy with shorter cooling times.

Keywords: ACP, antegrade cerebral perfusion; BMI, body mass index; BSA, body surface area; CPB, cardiopulmonary bypass; GFR, glomerular filtration rate; GI, gastrointestinal; HCA, hypothermic circulatory arrest; RCP, retrograde cerebral perfusion; aortic surgery; cardiopulmonary bypass; hypothermic circulatory arrest; rapid cooling.

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Figures

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Cardiopulmonary bypass setup to facilitate rapid cooling at a maximal temperature gradient.
Figure 1
Figure 1
Cardiopulmonary bypass circuit setup to facilitate rapid cooling at a maximal temperature gradient. The cooler temperature is initially set at 0 °C.
None
See this image and copyright information in PMC

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