A Modified Hypothermic Circulatory Arrest Technique Improves Early and Near-Midterm Results in Patients with Acute Type A Aortic Dissection

Abstract

Background: The hypothermic circulatory arrest (HCA) is an indispensable step in the surgical treatment of an acute type A aortic dissection (ATAAD), which could greatly affect the postoperative outcome. We modified the HCA technique and validated the feasibility and superiority of the new approach relative to the conventional method. Methods and results: Eighty-eight patients with ATAAD were enrolled in this study between May 2016 and April 2018. Of those, 36 patients in the Conventional treatment group had circulatory arrest at 25°C for about 16-28 minutes, while 52 patients in the Modification group underwent a circulatory arrest at 28°C for only 1-3 minutes. The preoperative clinical data and postoperative clinical outcomes were compared between the two groups. No intraoperative mortality occurred in any of the cases. No significant differences were observed in the aortic cross-clamp times during the cardiopulmonary bypass (CPB) between the two groups. In the Modification group, several indicators, such as mechanical ventilation time, postoperative 48-h drainage volume, blood transfusion volume, the ICU-stay time and postoperative hospital stay, were reduced significantly as compared with those in the Conventional group. Whereas three postoperative deaths in the hospital occurred in the Conventional treatment group, all the patients in the Modification group were cured. There is no difference in the incidence of postoperative complications between the two groups. The patients had a 100% follow up with a mean of 17 ± 6 months. Conclusions: A moderate hypothermia with a short circulatory arrest is a safe and effective HCA approach that provides satisfactory early and near-midterm results in the patients who received ATAAD treatment.