Warm aortic arch repair: Redefining proximal aortic arch surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• A novel warm aortic arch repair technique has been introduced, eliminating the need for hypothermic circulatory arrest.
• Comparative analyses between warm and conventional aortic arch repair are lacking.

Purpose of the Study:

• To compare the clinical outcomes of warm aortic arch repair with conventional aortic arch repair.
• To evaluate the safety and efficacy of the novel warm aortic arch repair technique.

Main Methods:

• A retrospective analysis of 919 patients undergoing hemiarch or partial arch repair between 2018 and 2024.
• Comparison of clinical outcomes between the warm aortic arch repair group (n=210) and the conventional arch repair group (n=709).
• Propensity score matching was used to control for baseline differences.

Main Results:

• The warm repair group demonstrated significantly shorter operative times and lower blood transfusion rates.
• Warm aortic arch repair was associated with lower rates of disabling stroke and a composite of mortality plus stroke.
• Postoperative metrics, including shorter intensive care unit and hospital stays, were improved in the warm repair group, though in-hospital mortality and stroke rates were similar after propensity score matching.

Conclusions:

• Warm aortic arch repair provides advantages in operative efficiency and postoperative outcomes compared to conventional repair with hypothermic circulatory arrest.
• The findings suggest a potential to reevaluate the necessity of hypothermic circulatory arrest in aortic arch surgery.
• Warm aortic arch repair is a safe and effective alternative, offering improved patient outcomes.