It Is Advisable to Control the Duration of Hypothermia Circulatory Arrest During Aortic Dissection Surgery: Single-Center Experience

Jian Song; Jinlin Wu; Xiaogang Sun; Xiangyang Qian; Bo Wei; Wei Wang; De Wang; Jiawei Qiu; Fangfang Cao; Wei Gao; Rui Zhao; Lu Dai; Shuya Fan; Enzehua Xie; Juntao Qiu; Xinjin Luo; Cuntao Yu

doi:10.3389/fcvm.2021.773268

It Is Advisable to Control the Duration of Hypothermia Circulatory Arrest During Aortic Dissection Surgery: Single-Center Experience

Front Cardiovasc Med. 2021 Dec 10:8:773268. doi: 10.3389/fcvm.2021.773268. eCollection 2021.

Authors

Jian Song¹, Jinlin Wu², Xiaogang Sun¹, Xiangyang Qian¹, Bo Wei¹, Wei Wang³, De Wang¹, Jiawei Qiu¹, Fangfang Cao⁴, Wei Gao¹, Rui Zhao¹, Lu Dai¹, Shuya Fan¹, Enzehua Xie¹, Juntao Qiu¹, Xinjin Luo³, Cuntao Yu¹

Affiliations

¹ Department of Vascular Surgery, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Cardiovascular Institute, Guangdong Academy of Medical Sciences, Guangzhou, China.
³ Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Intensive Care Unit, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Objective: The duration of hypothermic circulatory arrest (HCA) is one of the important factors affecting the prognosis of arch surgery, which is still controversial. The purpose of this study was to investigate the effect of HCA duration on early prognosis in type A aortic dissection (TAAD) patients who underwent arch surgery in our center. Methods: All consecutive patients who underwent surgical treatment for TAAD in Fuwai Hospital from January 2013 to December 2018 were included in this study and divided into four quartile groups based on HCA time. Baseline characteristics, perioperative indicators, and early mortality were statistically analyzed by propensity score matching (PSM) and restricted cubic spline (RCS) method. Perioperative adverse events were confirmed according to the American STS database and Penn classification. Results: About 1,018 consecutive patients (mean age 49.11 ± 1.4 years, male 74.7%) with TAAD treated surgically were eventually included in this study. After PSM, with the prolongation of HCA time, the surgical mortality rates of group [2,15], (15,18], (18,22], and (22,73] were 4.1, 6.6, 7.8, and 10.9% with p = 0.041, respectively. As shown in RCS, the mortality rate increased sharply after the HCA time exceeded 22 min. And from the subgroup analysis, the HCA time of 22 min or less was associated with better clinical outcomes (OR 2.09, 95%CI 1.25-3.45, p = 0.004). Conclusions: The early mortality increases significantly with the duration of HCA time when arch surgery was performed. And multiple systems throughout the body can be adversely affected.

Keywords: aortic dissection; aortic surgery; arch surgery; hypothermia circulatory arrest; prognosis.