Key result
Hypothermia ≥25°C during aortic arch surgery is linked to ~30% lower early mortality vs deeper cooling.
Why the study?
The optimal level of hypothermia during circulatory arrest in aortic arch surgery remains a matter of debate regarding its impact on mortality and morbidity.
Does moderate systemic hypothermia (≥ 25 °C) reduce early mortality and morbidity compared to deeper hypothermia in patients undergoing aortic arch surgery?
Meta-Analysis (n=32,323)
Does moderate systemic hypothermia (≥ 25 °C) reduce early mortality and morbidity compared to deeper hypothermia in patients undergoing aortic arch surgery?
Odds Ratio: 1.42 (95% CI 1.09–1.85)
p-value: p=0.01
Moderate hypothermia (≥ 25 °C) during circulatory arrest for aortic arch surgery is associated with reduced early mortality and perioperative stroke compared to deeper hypothermia.
Should not yet change temperature targets in aortic arch surgery; leaves open optimal depth pending randomized confirmation.
Objectives: Treatment of aortic pathologies involving the distal ascending aorta, aortic arch, and descending aorta remains a complex and challenging procedure. Appropriate management is important to achieve satisfactory outcome. Surgical management aims to reduce the time of circulatory arrest. The optimal level of hypothermia is still a matter of debate. The present meta-analysis shows the influence of different temperature levels on mortality and morbidity following aortic arch surgery. Methods: We performed a meta-analysis of published data between January 2000 and March 2020 based on a literature research. 120 studies were included with a total of 32 323 patients divided into three different groups of systemic hypothermia (temperature group 1: ≥ 25 °C, temperature group 2: 25-20°C, temperature group 3: ≤ 20°C) were used for statistical analysis. Results: Early mortality was lowest in temperature group 1 compared to group 2 (OR = 1.42; 95% CI, 1.09-1.85; p=0.01) and group 3 (OR = 1.74; 95% CI, 1.20–2.52; p=0.003). Perioperative stroke appeared to be less frequently in temperature group 1 versus group 2 (OR = 1.48; 95% CI, 1.20-1.82; p=0.0002) and group 3 (OR = 1.61; 95% CI, 1.19 - 2.18; p=0.002). Similar results are obtained concerning new renal insufficiency (group 1 versus group 2: OR = 1.20; 95% CI, 0.91-1.57, p=0.19; group 1 versus 3: OR = 0.94; 95% CI, 0.67 - 1.32, p=0.73) and re-exploration for bleeding (group 1 versus group 2: OR = 1.10; 95% CI, 0.80-1.53, p=0.55; group 1 versus group 3: OR = 1.92; 95% CI, 1.26 - 2.94, p=0,0025). Conclusions: We observed that moderate level of hypothermia during circulatory arrest reduced the incidence of early mortality. Most dreaded neurologic complications occurred less frequently in TG 1. In contrast there was no difference with regards with new onset of renal failure which is commonly accepted as a reliable marker of the quality of visceral organ protection.
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Huber et al. (2023) conducted a meta-analysis in aortic arch surgery (n=32,323). Systemic hypothermia ≥ 25 °C vs. Systemic hypothermia 25-20°C and ≤ 20°C was evaluated on Early mortality (OR 1.42, 95% CI 1.09-1.85, p=0.01). Systemic hypothermia ≥ 25 °C during aortic arch surgery was associated with lower early mortality compared to 25-20°C (OR 1.42; 95% CI 1.09-1.85; p=0.01) and ≤ 20°C.
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