Association between lower-body ischemia duration and postoperative visceral complications in thoracic aortic surgery

Gastrointestinal complications and acute pancreatitis after cardiac surgery are relatively rare; however, they may sometimes progress to serious conditions and can be challenging to manage. We aimed to investigate the association between lower-body circulatory arrest (LCA) time under mild-to-moderate hypothermia with antegrade selective cerebral perfusion (ASCP) and postoperative visceral complications in patients undergoing thoracic aortic surgery.

We retrospectively analyzed 221 patients who underwent thoracic aortic surgery for degenerative aneurysms involving the ascending aorta and aortic arch with LCA under mild-to-moderate hypothermia between 2015 and 2025. The associations between LCA time and postoperative complications, including gastrointestinal complications and pancreatitis, were evaluated using logistic regression analyses.

Prolonged LCA time was significantly associated with an increased incidence of postoperative gastrointestinal (P = 0.006) and lung complications (P = 0.02) in logistic regression models adjusted for minimal temperature. A similar trend was observed for AKI without statistical significance (P = 0.08). In contrast, acute pancreatitis was not associated with LCA time. Within the studied temperature range, minimal temperature was not significantly associated with visceral complications.

Prolonged LCA time under mild-to-moderate hypothermia using ASCP was significantly associated with increased postoperative gastrointestinal and lung complications, whereas pancreatitis was not associated. The duration of lower-body ischemia may be an important determinant of visceral organ injury within the studied temperature range.