Abstract
Background. Deep hypothermic circulatory arrest (DHCA) at ≤20°C
for aortic arch surgery has been widely used for decades, with or
without cerebral perfusion (CP), antegrade (ACP) or retrograde. In
recent years nadir temperature progressively increased to 26-28 °C
(moderately hypothermic circulatory arrest, MHCA), adding ACP. Aim of
this multicentric study is to evaluate early results of aortic arch
surgery and if DHCA with 10-minute of cold reperfusion at the same nadir
temperature of the CA before rewarming (delayed rewarming, DR) can
provide a neuroprotection and a lower body protection similar to that
provided by MHCA+ACP. Methods. Two-hundred-ten patients were
included in the study. DHCA+DR was used in 59 patients and MHCA+ACP in
151. Primary endpoints were death, neurologic event (NE), temporary
(TNE) or permanent (permanent neurologic deficit, PND), and need of
renal replacement therapy (RRT). Results. Operative mortality
occurred in 14 patients (6.7%), NEs in 17 (8.1%) and PNDs in 10
(4.8%). Twenty-three patients (10.9%) needed RRT. Death+PND occurred
in 21 patients (10%) and composite endpoint in 35 (19.2%). Intergroup
weighed logistic regression analysis showed similar prevalence of
deaths, NDs and death+PND, but need of RRT (OR 7.39, CI 1.37-79.1) and
composite endpoint (OR 8.97, CI 1.95-35.3) were significantly lower in
DHCA+DR group compared with MHCA+ACP group. Conclusions. The
results of our study demonstrate that DHCA+DR has the same prevalence of
operative mortality, NE and association of death+PND than MHCA+ACP.
However, the data suggests that DHCA+DR when compared with MHCA+ACP
provides better renal protection and reduced prevalence of composite
endpoint.