Influence of Hypothermic Circulatory Arrest Duration and Temperature on Postoperative Morbidity, Mortality, and Neurological Outcomes in Aortic Surgery
Circulatory Arrest and Its Outcomes in Aortic Surgery
DOI:
https://doi.org/10.5281/zenodo.21959313Keywords:
aortic surgery, aortic dissection, , total circulatory arrest, cerebral perfusionAbstract
Influence of Hypothermic Circulatory Arrest Duration and Temperature on Postoperative Morbidity, Mortality, and Neurological Outcomes in Aortic Surgery
Background: Aortic surgery under total circulatory arrest (TCA) carries significant risks of neurological injury and mortality. The optimal combination of hypothermia depth and cerebral perfusion strategy remains debated.
Objectives: To evaluate the impact of TCA duration, hypothermia level, and cerebral perfusion modality—antegrade (ACP) vs. retrograde (RCP)—on outcomes in Stanford type A aortic dissection repair.
Materials and Methods: We retrospectively analyzed 231 patients (2004–2014) undergoing aortic surgery with TCA. Demographic data, operative variables, hypothermia levels, and perfusion strategies were assessed. Statistical analysis included nonparametric tests and Kaplan–Meier survival curves.
Results: Mean age was 55.9 ± 12.2 years (70.6% male). Mean TCA duration was 29.3 ± 10.4 minutes. ACP was used in 59.3% and RCP in 40.7% of cases. Overall mortality was 38.1%; neurological complications occurred in 18.4%. No significant differences in mortality or neurological outcomes were found between ACP and RCP for standard TCA durations (p > 0.05). However, hypothermia degree significantly influenced outcomes (p < 0.05). Moderate hypothermia (20–22°C) demonstrated the highest survival, while deeper hypothermia (16–18°C) was associated with increased mortality. Kaplan–Meier analysis confirmed significant survival differences across temperature groups (log-rank p = 0.009).
Conclusions: When TCA duration is limited, ACP and RCP provide comparable clinical outcomes. Moderate hypothermia (20–22°C) offers an optimal balance between neuroprotection and systemic safety. These findings support an individualized approach and confirm that RCP remains a reliable alternative to ACP in aortic surgery.
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