Deep hypothermic circulatory arrest versus non-deep hypothermic beating heart strategy in descending thoracic or thoracoabdominal aortic surgery

Abstract

OBJECTIVES: The ideal cardiopulmonary bypass (CPB) strategy during open surgical repair of the descending thoracic aorta (DTA) or thoracoabdominal aorta (TAA) is controversial. This study aimed to compare the clinical outcomes between deep hypothermic circulatory arrest (DHCA) and non-deep hypothermic beating heart CPB (non-DHCA) for DTA or TAA replacement. METHODS: From January 1994 to August 2011, 259 patients underwent DTA or TAA replacement. Of these, 212, who were judged to be suitable for both DHCA (n = 79) and non-DHCA (n = 109), were analysed. In-hospital outcomes were compared using propensity scores and inverse-probability-weighting adjustment based on 20 preoperative variables to reduce treatment selection bias. RESULTS: Early mortality was 12.7% in the DHCA group and 7.5% in the non-DHCA group (P = 0.23). Major adverse outcomes included stroke in 13 patients (6.1%), paraplegia in 10 (4.7%), low cardiac output syndrome (LCOS) in 17 (8.0%) and multiorgan failure in 12 (5.7%). After adjustment, patients who underwent DHCA were at a risk of death (odds ratio (OR), 1.86; P = 0.18) and permanent neurological injury (OR, 1.06; P = 0.90) similar to that of those who underwent non-DHCA, but at greater risk of LCOS (OR, 3.85; P = 0.012). Furthermore, prolonged ventilator support (>24 h) was more frequent with DHCA than with non-DHCA (OR, 2.33; P = 0.004). CONCLUSIONS: Compared with non-DHCA, DHCA was associated with greater risk of postoperative LCOS and prolonged ventilator support. Therefore, non-DHCA seems to be a more appropriate option than DHCA for open DTA/TAA repair whenever the aortic anatomy lends itself to this approach.