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Comparative Study
. 2025 Jan 20;25(1):32.
doi: 10.1186/s12872-024-04443-4.

Impact of mild hypothermic circulatory arrest on surgical outcomes in acute type a aortic dissection patients: a single-centre study

Zhenxiong Li #  1 , Hao Tang  1 , Chao Deng  1 , Kangjun Shen  1 , Jingyu Li  1 , Song Tian  1 , WenYao Zhan  1 , Ling Tan  2
Affiliations
Comparative Study

Impact of mild hypothermic circulatory arrest on surgical outcomes in acute type a aortic dissection patients: a single-centre study

Zhenxiong Li et al. BMC Cardiovasc Disord. .

Abstract

Background: As hypothermic circulatory arrest (HCA) is being more frequently induced in patients undergoing aortic arch surgery, its safety at different degrees has become a crucial area of study. The aim of this study was to assess the surgical outcomes of mild hypothermic circulatory arrest (MI-HCA) during aortic arch surgery.

Methods: Acute type A aortic dissection (ATAAD) patients who underwent total arch replacement (TAR) and frozen elephant trunk (FET) surgery between January 2014 and December 2023 were enrolled in this study. The patients were divided into two groups according to the minimum nasopharyngeal temperature: the moderate hypothermic circulatory arrest (MHCA) group (20-28 °C) and the MI-HCA group (> 28 °C). The inverse probability of treatment weighting (IPTW) was used to balance differences in the baseline characteristics. Perioperative variables were analysed via pairwise comparisons, multivariable logistic regression, and subgroup forest plots to assess the impact of MI-HCA on surgical outcomes.

Results: A total of 447 patients were included in this study, and the mean minimum nasopharyngeal temperature was 24.80 (23.98, 27.30) °C in the MHCA group and 30.10 (29.80, 30.70) °C in the MI-HCA group. The incidence of acute kidney injury (AKI) in the MI-HCA group was lower than that in the MHCA group (52% vs. 78%, p < 0.01). In the multivariable logistic regression analysis, MI-HCA was identified as an independent protective factor for AKI (OR = 0.354, 95% CI 0.177-0.689; p = 0.003). Additionally, compared with MHCA, MI-HCA was not associated with an increased incidence of stroke, spinal cord injury, or in-hospital mortality. After IPTW, the preoperative and intraoperative data of the patients were balanced, and the incidence of AKI in the MI-HCA group was still lower than that in the MHCA group (83.26% vs. 53.61%, p = 0.004). The subgroup forest plot also demonstrated that MI-HCA was a protective factor for postoperative AKI.

Conclusions: The surgical outcomes of MI-HCA in ATAAD patients were satisfactory. Compared with MHCA, MI-HCA provided sufficient protection for distal organs, the brain, and the spinal cord, with a significantly lower incidence of AKI. These results indicate that MI-HCA could be a better approach for ATAAD surgery.

Keywords: Acute kidney injury; Acute type a aortic dissection; Inverse probability of treatment weighting; Mild hypothermic circulatory arrest; Subgroup forest plot; Surgical outcomes.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was reviewed and approved by the ethics committee of the Second Xiangya Hospital of Central South University, and the approval number is LYF2023113. All patients provided written informed consent for the use of access to their retrospective data and samples in research. Consent for publication: Not applicable. Competing interests: The authors declare that they have no competing interests. Clinical trial number: Not applicable.

Figures

Fig. 1
Fig. 1
Flow chart of the MHCA patients and the MI-HCA patients
Fig. 2
Fig. 2
Subgroup analyses of the effect of MI-HCA on AKI after IPTW. *P value for interaction between two variables (MI-HCA and subgroup variables)
See this image and copyright information in PMC

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