Normothermic Circulatory Arrest with Antegrade Cerebral Perfusion for Type A Aortic Dissection

Laura Rings ^1,2, Rasha Boulos ^1,3, Vasileios Ntinopoulos ^1,2

⁰Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland.

The Thoracic and Cardiovascular Surgeon +

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May 2, 2025

View abstract on PubMed

Summary

Normothermic circulatory arrest (NTCA) with antegrade cerebral perfusion is a feasible and safe alternative for acute type A aortic dissection repair. This approach showed shorter cross-clamp times and improved coagulation compared to mild hypothermia.

Area Of Science

Cardiovascular Surgery
Thoracic Surgery
Aortic Surgery

Background

Deep hypothermic circulatory arrest is the standard for acute type A aortic dissection repair.
Exploring alternatives to hypothermia is crucial for improving patient outcomes.

Purpose Of The Study

To evaluate the feasibility and outcomes of normothermic circulatory arrest (NTCA) with antegrade cerebral perfusion.
To compare NTCA with mild hypothermic circulatory arrest in patients with acute type A aortic dissection.

Main Methods

Retrospective propensity score-matched analysis of patients undergoing surgery for acute type A aortic dissection (2007-2023).
Comparison of outcomes between normothermic (>35°C) and mild hypothermic (28-34°C) circulatory arrest groups.
Primary outcomes included 30-day mortality, new neurological deficits, and operative parameters.

Main Results

The NTCA group had significantly shorter aortic cross-clamp times (47.5 vs. 66.5 minutes).
Trends towards shorter cardiopulmonary bypass times, ICU stays, and intubation times were observed in the NTCA group.
No significant differences in neurological deficits, delirium, or mortality were found; NTCA required less prothrombin complex concentrate.

Conclusions

Normothermic circulatory arrest with antegrade cerebral perfusion is feasible and safe for hemiarch repair in acute type A aortic dissection.
Potential benefits include shorter operative times and improved coagulation.
Larger prospective studies are warranted to confirm these findings.