Impact of mild hypothermic circulatory arrest on surgical outcomes in acute type a aortic dissection patients: a single-centre study

BMC Cardiovascular Disorders, 2025 · DOI: https://doi.org/10.1186/s12872-024-04443-4 · Published: January 21, 2025

Simple Explanation

This study investigates the safety of using mild hypothermia during aortic arch surgery. Hypothermia, or cooling the body, helps protect the brain during surgery. The researchers compared patients undergoing surgery with moderate cooling to those with mild cooling. The study found that patients with mild hypothermia had fewer kidney problems after surgery. There was no increased risk of stroke or spinal cord injury with milder cooling. The results suggest that using milder cooling during aortic arch surgery can still protect the brain and spinal cord, while also reducing the risk of kidney injury. This could lead to better outcomes for patients undergoing this type of surgery.

Study Duration

January 2014 to December 2023

Participants

447 patients with acute type A aortic dissection

Evidence Level

Not specified

Key Findings

1
MI-HCA was associated with a shorter CPB time, and reduced blood transfusion requirements.
2
The incidence of AKI in the MI-HCA group was lower than that in the MHCA group (52% vs. 78%, p < 0.01).
3
MI-HCA provided sufficient protection for distal organs, the brain, and the spinal cord, with a significantly lower incidence of AKI.

Research Summary

This retrospective study of 447 ATAAD patients undergoing urgent TAR and FET found that MI-HCA was associated with shorter CPB time and reduced blood transfusion needs. MI-HCA patients had better postoperative outcomes, including shorter mechanical ventilation time, quicker consciousness recovery, and significantly lower incidence of AKI, without increasing the risk of neurological complications. The study concludes that MI-HCA provides sufficient protection for distal organs and the spinal cord, making it a potentially better approach for ATAAD surgery compared to MHCA.

Practical Implications

Reduced AKI Risk

MI-HCA may be a better strategy to decrease the risk of ischemia-reperfusion injury, leading to reductions in proinflammatory responses and subsequent kidney injury.

Shorter Hospital Stays

The association between MI-HCA and shorter hospital stays can lead to reduced healthcare costs and improved patient turnover.

Effective Organ Protection

MI-HCA can meet cerebral protection requirements during ATAAD surgery without increasing the incidence of stroke, indicating effective organ protection.

Study Limitations

1
Single-center retrospective study, prone to selection bias.
2
Lack of randomization affects results.
3
Hypothermia definition based on 2013 consensus guidelines using nasopharyngeal temperature, whereas 2023 guidelines use bladder temperature.

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