Optimal circulatory arrest temperature for aortic hemiarch replacement with antegrade brain perfusion

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Medical Hypothermia

Background:

• Elective hemiarch replacement is a complex procedure for aneurysmal disease.
• Antegrade brain perfusion is used to protect the brain during circulatory arrest.
• Optimizing patient outcomes requires precise control of intraoperative conditions, including temperature.

Purpose of the Study:

• To determine the optimal temperature for moderate hypothermic circulatory arrest during elective hemiarch replacement with antegrade brain perfusion.
• To identify temperature ranges associated with improved survival and reduced morbidity.

Main Methods:

• Analysis of the Society of Thoracic Surgeons adult cardiac surgery database (2014-2019).
• Inclusion of patients undergoing elective hemiarch replacement with antegrade brain perfusion for aneurysmal disease.
• Utilized generalized estimating equations and restricted cubic splines to analyze risk-adjusted relationships between temperature and outcomes.

Main Results:

• A total of 3898 patients were analyzed, with a median nadir temperature of 24.9°C.
• Temperatures between 25°C and 28°C were associated with an early survival advantage compared to 24°C.
• Nadir temperatures of 27°C showed the lowest risk-adjusted odds of mortality (OR, 0.62) and morbidity.
• Temperatures between 21°C and 23°C, particularly 21°C, were linked to higher risks of mortality and major morbidity.

Conclusions:

• A nadir temperature of 27°C during moderate hypothermic circulatory arrest is optimal for elective hemiarch replacement with antegrade brain perfusion.
• This temperature strategy maximizes early survival and minimizes postoperative complications.
• Avoiding temperatures below 23°C is crucial for reducing mortality and morbidity risks.