Temperature analysis of aortic repair with hypothermic circulatory arrest to quantify the injury by cooling

Abstract OBJECTIVES We analyzed the temperature in proximal aortic repair with moderate hypothermic circulatory arrest (HCA) and evaluated the effect of the cooling status on postoperative outcomes. METHODS A total of 340 patients who underwent elective ascending aortic replacement or total arch rep...

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Published in:	Interdisciplinary cardiovascular and thoracic surgery Vol. 36; no. 1
Main Authors:	Sato, Hiroshi, Iba, Yutaka, Kawaharada, Nobuyoshi, Fukada, Joji, Iwashiro, Yuu, Tsushima, Shingo, Hosaka, Itaru, Okawa, Akihito, Shibata, Tsuyoshi, Nakazawa, Jyunji, Nakajima, Tomohiro, Hasegawa, Takeo, Tamiya, Yukihiko
Format:	Journal Article
Language:	English
Published:	England Oxford University Press 09-01-2023
Subjects:	Vascular Aortic repair Hypothermic circulatory arrest Clinical outcome Temperature analysis
Online Access:	Get full text
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Summary:	Abstract OBJECTIVES We analyzed the temperature in proximal aortic repair with moderate hypothermic circulatory arrest (HCA) and evaluated the effect of the cooling status on postoperative outcomes. METHODS A total of 340 patients who underwent elective ascending aortic replacement or total arch replacement with moderate HCA from December 2006 to January 2021 were studied. The change in body temperature trends recorded during surgery was shown graphically. Several parameters, such as the nadir temperature, cooling speed and the degree of cooling (cooling area), which was the area under curve of inverted temperature trends from cooling to rewarming as calculated by the integral method, were analyzed. The relationships between these variables and a major adverse outcome (MAO) postoperatively defined as prolonged ventilation (>72 h), acute renal failure, stroke, reoperation for bleeding, deep sternal wound infection or in-hospital death were evaluated. RESULTS An MAO was observed in 68 patients (20%). The cooling area was larger in the MAO group than in the non-MAO group (1668.7 vs 1383.2°C min; P < 0.0001). A multivariate logistic model showed that old myocardial infarction, peripheral vascular disease, chronic renal dysfunction, cardiopulmonary bypass time and the cooling area were independent risk factors for an MAO (odds ratio = 1.1 per 100°C min; P < 0.001). CONCLUSIONS The cooling area, which indicates the degree of cooling, shows a significant relationship with an MAO after aortic repair. This finding indicates that the cooling status with HCA can affect clinical outcomes. Ascending aortic replacement (AAR) and total arch replacement (TAR) with hypothermic circulatory arrest (HCA) for an aortic aneurysm are established surgeries and have favourable clinical results [1–3].
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	2753-670X 2753-670X
DOI:	10.1093/icvts/ivac282