Key result
DHCA ≥60 minutes is not linked to increased 30-day mortality versus shorter durations.
Why the study?
It is controversial whether the duration of deep hypothermic circulatory arrest is associated with adverse outcomes in patients with acute type A aortic dissection undergoing surgery.
Does deep hypothermic circulatory arrest duration ≥ 60 minutes worsen surgical outcomes in patients with acute type A aortic dissection?
Cohort (n=410)
No
Does deep hypothermic circulatory arrest duration ≥ 60 minutes worsen surgical outcomes in patients with acute type A aortic dissection?
Absolute Event Rate: 15.1% vs 16.6%
p-value: p=0.746
Surgical treatment of acute type A aortic dissection using DHCA with selective antegrade cerebral perfusion can be safely performed even with DHCA durations ≥60 minutes without increasing 30-day mortality.
(1) Background: Deep hypothermic circulatory arrest (DHCA) with selective antegrade cerebral perfusion (ACP) is an established cerebral protection technique for the conduction of complex surgical procedures involving the aortic arch. It is controversial whether the duration of DHCA is associated with adverse outcome in patients with acute type A aortic dissection (AAAD). Our goal was to investigate whether DHCA time was associated with surgical outcome in patients undergoing a surgical treatment of AAAD. (2) Methods: A total of 410 patients were divided into two groups based on the DHCA time less than 60 min and equal to or longer than 60 min. (3) Results: Patients with longer DHCA times were significantly younger (p = 0.001). Intraoperatively, complex procedures with aortic arch surgery were more common in patients with longer DHCA times (p < 0.001). Accordingly, cardiopulmonary bypass (p < 0.001), cross-clamping (p < 0.001) and DHCA times (p < 0.001) were significantly longer in this group. Postoperatively, only the duration of mechanical ventilation (p < 0.001) and the rate of tracheotomy were significantly higher in these patients. Thirty-day mortality was satisfactory for both groups (p = 0.746). (4) Conclusions: Our results showed that improvements in perioperative management including ACP allow for the successful performance of surgical treatment of AAAD under DHCA with a duration of even longer than 60 min.
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Ravesh et al. (2022) conducted a cohort in Acute Type A Aortic Dissection (n=410). Deep hypothermic circulatory arrest (DHCA) ≥ 60 minutes vs. DHCA < 60 minutes was evaluated on 30-day mortality (p=0.746). A deep hypothermic circulatory arrest duration of 60 minutes or longer during surgery for acute type A aortic dissection was not associated with increased 30-day mortality compared to a duration under 60 minutes (15.1% vs 16.6%, p=0.746).
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