Effects of temperature on transient neurologic dysfunction after total arch replacement

Area of Science:

• Cardiovascular Surgery
• Neurology
• Hypothermia Research

Background:

• The impact of intraoperative cooling on neurologic outcomes after aortic surgery remains unclear.
• Transient neurologic dysfunction (TND) is a potential complication following aortic arch replacement.

Purpose of the Study:

• To investigate the association between intraoperative cooling status and the incidence of TND after total arch replacement.
• To identify specific cooling parameters that may predict TND.

Main Methods:

• Analysis of tympanic temperature trends in 228 patients undergoing total arch replacement with hypothermic circulatory arrest.
• Evaluation of cooling parameters including nadir temperature, cooling speed, and cooling area (degree of cooling).
• Statistical analysis to determine the relationship between cooling variables and TND.

Main Results:

• TND occurred in 14.5% of patients.
• Patients with TND exhibited a larger cooling area and higher cooling speed compared to those without TND.
• Multivariate analysis identified cooling area and cooling speed as independent risk factors for TND.

Conclusions:

• Both the degree of cooling (cooling area) and the speed of cooling are significantly associated with TND.
• Overcooling and excessively rapid cooling may contribute to postoperative brain injury.
• Optimizing cooling strategies during aortic surgery is crucial for mitigating neurologic complications.