Impact of high-moderate hypothermic circulatory arrest on postoperative major adverse events in acute Type A aortic dissection

Wei Wang; Jinhua Wei; Zhan Hu; Yu Du; Chunyuan Wang; Rong Wu; Fei Xu

doi:10.1016/j.ijcard.2025.133561

Impact of high-moderate hypothermic circulatory arrest on postoperative major adverse events in acute Type A aortic dissection

Int J Cardiol. 2025 Jun 26:133561. doi: 10.1016/j.ijcard.2025.133561. Online ahead of print.

Authors

Wei Wang¹, Jinhua Wei¹, Zhan Hu¹, Yu Du¹, Chunyuan Wang¹, Rong Wu¹, Fei Xu²

Affiliations

¹ Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.
² Cardiovascular Surgery Department, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.. Electronic address: felix_xufei@126.com.

PMID: 40581108
DOI: 10.1016/j.ijcard.2025.133561

Abstract

Objective: To compare the effect of high-moderate hypothermic circulatory arrest (HMHCA) versus low-moderate and deep hypothermic circulatory arrest (LDHCA) on postoperative major adverse events (MAEs) after aortic repair procedure for patients with acute type A aortic dissection (ATAAD).

Methods: Between January 2013 and December 2021, a total of 555 patients were treated with aortic repair procedure utilizing the HMHCA strategy and 262 patients utilizing the LDHCA strategy. The impact of different HCA temperatures on the postoperative MAEs was evaluated through the comparison between the HMHCA group and the LDHCA group.

Results: The mean age was 48.6 ± 10.8 in the HMHCA group and 47.2 ± 10.4 in the LDHCA group (P = 0.086), with similar female gender distribution (22.3 % vs 24.4 %, P = 0.533). The frequency of preoperative cerebral malperfusion syndrome was lower in the HMHCA group than the LDHCA group (7.0 % vs 11.0 %, P = 0.058). The duration of cardiopulmonary bypass was comparable between the two groups; however, patients in the HMHCA group exhibited longer duration of aortic cross-clamp and shorter duration of HCA process. Bilateral cerebral perfusion was utilized in 11.2 % of HMHCA group and 0.8 % of LDHCA group (P < 0.001). The morbidity of postoperative MAEs was 34.2 % in the HMHCA group and 44.1 % in the LDHCA group (P = 0.008). Multivariable logistic regression analysis demonstrated that HMHCA temperature was significantly associated with lower incidence of postoperative MAEs (OR = 0.601, 95 % CI 0.393-0.919, P = 0.019).

Conclusions: The utilization of high-moderate HCA presents with superior postoperative outcomes compared with low-moderate and deep HCA in patients with ATAAD.

Keywords: Acute type a aortic dissection; High-moderate; Hypothermic circulatory arrest; Low-moderate; Major adverse events.