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

Deep hypothermic circulatory arrest is the standard approach for the surgical repair of acute type A aortic dissection. This study aimed to evaluate the feasibility and outcomes of normothermic circulatory arrest using antegrade cerebral perfusion as an alternative technique.

A retrospective propensity score-matched analysis was conducted on patients undergoing surgery for acute type A aortic dissection between 2007 and 2023 at a single center. Outcomes were compared between patients who underwent normothermic (>35°C) versus mild hypothermic (28-34°C) circulatory arrest. The primary outcomes were 30-day mortality, new neurological deficits, and the intraoperative and postoperative parameters.

After propensity score matching, 20 pairs were analyzed. The normothermic group (NTCA) had significantly shorter aortic cross-clamp times (47.5 vs. 66.5 minutes, p = 0.013) and trends toward shorter cardiopulmonary bypass times (68 vs. 95 minutes, p = 0.066), ICU stays (4.5 vs. 5 days, p = 0.4), and intubation times (6 vs. 8 hours, p = 0.4). There were no significant differences in new neurological deficits (n = 6 [NTCA] vs. 4, p = 0.7), delirium (n = 5 [NTCA] vs. 6, p = 0.6), or mortality (n = 1 [NTCA] vs. 3, p = 0.6) between the groups. The normothermic group required less prothrombin complex concentrate (p = 0.0012).

In this pilot study, NTCA with antegrade cerebral perfusion appears feasible and safe for hemiarch repair in acute type A aortic dissection, with potential benefits of shorter operative times and improved coagulation profiles compared with mild hypothermia. Larger prospective studies are needed to confirm these findings.