Hypothermic circulatory arrest is not a risk factor for neurologic morbidity in aortic surgery: a propensity score analysis.
OBJECTIVE
Hypothermic circulatory arrest has been an important tool in aortic arch surgery, even though its use has recently been discussed controversially. We sought to clarify the role of hypothermic circulatory arrest as a risk factor for mortality and neurologic morbidity in aortic surgery by using a propensity score-matching analysis.


METHODS
Five hundred eleven patients (60 +/- 13 years, 349 male patients) who underwent replacement of the ascending aorta with (n = 273) or without (n = 238) arch involvement were analyzed by means of multivariate analysis. Using propensity score matching, we identified comparable patient groups: HCA(+) group and HCA(-) group (n = 110 each). For aortic arch replacement, hypothermic circulatory arrest was used with a mean duration of 14 +/- 9 minutes: 12 +/- 7 minutes or 26 +/- 8 minutes for partial or total arch replacement, respectively.


RESULTS
In the entire cohort multivariate analysis identified acute dissection and duration of cardiopulmonary bypass as significant predictors for hospital death. Predictors for stroke were acute dissection, diabetes mellitus, peripheral arterial disease, and concomitant mitral valve surgery, and predictors for temporary neurologic dysfunction were peripheral arterial disease and age. After propensity score matching, the incidence of death (HCA[+]: 0.9% vs HCA[-]: 2.7%), stroke (0% vs 1.8%, respectively), and temporary neurologic dysfunction (15.5% vs 13.6%, respectively) was comparable between the 2 groups. Multivariate analysis identified age, diabetes mellitus, peripheral arterial disease, and concomitant coronary artery bypass grafting as the independent risk factors for temporary neurologic dysfunction.


CONCLUSIONS
In a standard clinical setting (hypothermic circulatory arrest of <30 minutes and nasopharyngeal temperature of <20 degrees C), hypothermic circulatory arrest constitutes no significant risk for mortality or neurologic morbidity and thus appears clinically safe. Patient-related risk factors primarily determine clinical outcome.
Kunihara
Takashi
T
Department of Thoracic and Cardiovascular Surgery, University Hospital Homburg, Homburg, Germany.
Grün
Timo
T
Aicher
Diana
D
Langer
Frank
F
Adam
Oliver
O
Wendler
Olaf
O
Saijo
Yasuaki
Y
Schäfers
Hans-Joachim
HJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001019:Aortic Rupture / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects*; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009422:Nervous System Diseases / Q000209:etiology*; D012307:Risk Factors; D020521:Stroke / Q000209:etiology