Brain and lower body protection during aortic arch surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Deep hypothermic circulatory arrest (DHCA) at ≤20°C has been a standard for aortic arch surgery.
• Recent trends favor moderately hypothermic circulatory arrest (MHCA) at 26°C-28°C with antegrade cerebral perfusion (ACP).
• This study investigates DHCA with delayed rewarming (DR) as an alternative neuroprotective and organ-protective strategy.

Purpose of the Study:

• To compare early outcomes of aortic arch surgery using DHCA+DR versus MHCA+ACP.
• To evaluate the neuroprotective and body protection efficacy of DHCA+DR.
• To assess the impact on mortality, neurologic events, and renal replacement therapy.

Main Methods:

• A multicenter study included 210 patients undergoing aortic arch surgery.
• 59 patients received DHCA+DR, while 151 patients underwent MHCA+ACP.
• Primary endpoints included death, neurologic events (NE), permanent neurologic deficit (PND), and renal replacement therapy (RRT).

Main Results:

• Overall operative mortality was 6.7%, NEs occurred in 8.1%, and PNDs in 4.8% of patients.
• RRT was required in 10.9% of patients.
• DHCA+DR demonstrated significantly lower rates of RRT (OR: 7.39) and a composite endpoint (OR: 8.97) compared to MHCA+ACP.

Conclusions:

• DHCA+DR and MHCA+ACP exhibit comparable rates of operative mortality, NEs, and death+PND.
• DHCA+DR offers superior renal protection compared to MHCA+ACP.
• The findings suggest DHCA+DR is a viable strategy for aortic arch surgery, potentially reducing composite adverse events.