Warm aortic arch repair: Redefining proximal aortic arch surgery

We recently introduced warm aortic arch repair, a new novel approach that obviates the need for hypothermic circulatory arrest. However, there have been no comparative analyses with conventional repair.

Between 2018 and 2024, 919 patients underwent hemiarch or partial arch repair. Clinical outcomes were compared between the warm aortic arch repair (n = 210) and conventional arch repair (n = 709) groups.

Baseline clinical characteristics were similar in the 2 groups, except type A aortic dissection was more common in the conventional repair group (49.2% vs 31.9%; P < .001). The warm repair group had significantly shorter cardiopulmonary bypass, cross-clamp, cerebral perfusion, and operative times, as well as a lower blood transfusion rate, compared to the conventional repair group. In-hospital mortality was similar (2.4% vs 3.9%; P = .28), the warm repair group had lower rates of disabling stroke (2.4% vs 6.5%; P = .022) and a composite outcome of mortality plus stroke (4.3% vs 9.9%; P = .011), along with lower rates of prolonged ventilation, renal failure, new dialysis, and shorter intensive care unit and hospital lengths of stay. After 1:1 propensity score matching among patients with hemiarch with or without aortic valve replacement, with a similar number of type A dissections in the 2 groups, the warm repair group's advantages in operative efficiency and postoperative metrics persisted. However, there were no between-group differences in in-hospital mortality (2.1% vs 3.1%; P = 1.00), disabling stroke (1.0% vs 3.1%; P = .62), or composite outcomes (3.1% vs 6.2%; P = .31).

Although the conventional aortic arch repair approach with hypothermic circulatory arrest is safe, warm aortic arch repair offers advantages, including better operative efficiency, lower transfusion rates, and improved postoperative metrics. This technique represents an opportunity to reevaluate the role of hypothermic circulatory arrest in aortic arch surgery.