Temperature Management During Circulatory Arrest in Cardiac Surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Neurosurgery

Background:

• Complex aortic arch surgery presents significant technical and strategic challenges.
• Deep hypothermia and circulatory arrest enabled modern aortic surgery but carried risks.
• Selective cerebral perfusion (SCP) improved neuroprotection and outcomes in aortic surgery.

Purpose of the Study:

• To review the evolution of temperature management strategies in complex aortic arch surgery.
• To discuss the benefits and risks associated with deep hypothermia, SCP, and normothermia.
• To highlight potential underreporting of adverse outcomes from inappropriate temperature management.

Main Methods:

• Historical review of temperature management in aortic arch surgery.
• Analysis of the role of deep hypothermia and circulatory arrest.
• Evaluation of the development and application of selective cerebral perfusion.

Main Results:

• Deep hypothermia with circulatory arrest was initially standard.
• Selective cerebral perfusion allowed for higher body temperatures, reducing hypothermia's adverse effects.
• Inappropriate temperature management, especially too high temperatures, may lead to underreported adverse outcomes.

Conclusions:

• The trend towards moderate hypothermia or normothermia in aortic surgery, while aiming to reduce complications, may introduce new risks.
• Careful temperature management is crucial to balance the benefits of reduced hypothermia-related issues and the risks of inadequate brain protection.
• Further investigation into the precise temperature thresholds and their impact on outcomes is warranted.