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Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database.

Publication ,  Journal Article
Englum, BR; He, X; Gulack, BC; Ganapathi, AM; Mathew, JP; Brennan, JM; Reece, TB; Keeling, WB; Leshnower, BG; Chen, EP; Jacobs, JP; Hughes, GC ...
Published in: Eur J Cardiothorac Surg
September 1, 2017

OBJECTIVES: Hypothermic circulatory arrest is essential to aortic arch surgery, although consensus regarding optimal cerebral protection strategy remains lacking. We evaluated the current use and comparative effectiveness of hypothermia/cerebral perfusion (CP) strategies in aortic arch surgery. METHODS: Using the Society of Thoracic Surgeons Database, cases of aortic arch surgery with hypothermic circulatory arrest from 2011 to 2014 were categorized by hypothermia strategy-deep/profound (D/P; ≤20°C), low-moderate (L-M; 20.1-24°C), and high-moderate (H-M; 24.1-28°C)-and CP strategy-no CP, antegrade (ACP), retrograde (RCP) or both ACP/RCP. After adjusting for potential confounders, strategies were compared by composite end-point (operative mortality or neurologic complication). RESULTS: Of the 12 521 aortic arch repairs with hypothermic circulatory arrest, the most common combined strategies were straight D/P without CP (25%), D/P + RCP (16%) and D/P + ACP (14%). Overall rates of the primary end-point, operative mortality and stroke were 23%, 12% and 8%, respectively. Among the 7 most common strategies, the 2 not utilizing CP (straight D/P and straight L-M) appeared inferior, associated with significantly higher risk of the composite end-point (odds ratio: 1.6; P < 0.01); there was no significant difference in composite outcome between the remaining strategies (D/P + ACP, D/P + RCP, L-M + ACP, L-M + RCP and H-M + ACP). CONCLUSIONS: In a comparative effectiveness study of cerebral protection strategies for aortic arch repair, strategies without adjunctive CP, including the most commonly utilized strategy of straight D/P hypothermia, appeared inferior to those utilizing CP. There was no clearly superior strategy among remaining techniques, and randomized trials are needed to define best practice.

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Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

September 1, 2017

Volume

52

Issue

3

Start / End Page

492 / 498

Location

Germany

Related Subject Headings

  • United States
  • Survival Rate
  • Risk Factors
  • Respiratory System
  • Incidence
  • Humans
  • Hospital Mortality
  • Databases, Factual
  • Circulatory Arrest, Deep Hypothermia Induced
  • Cerebrovascular Circulation
 

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Englum, B. R., He, X., Gulack, B. C., Ganapathi, A. M., Mathew, J. P., Brennan, J. M., … Hughes, G. C. (2017). Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database. Eur J Cardiothorac Surg, 52(3), 492–498. https://doi.org/10.1093/ejcts/ezx133
Englum, Brian R., Xia He, Brian C. Gulack, Asvin M. Ganapathi, Joseph P. Mathew, J Matthew Brennan, T Brett Reece, et al. “Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database.Eur J Cardiothorac Surg 52, no. 3 (September 1, 2017): 492–98. https://doi.org/10.1093/ejcts/ezx133.
Englum BR, He X, Gulack BC, Ganapathi AM, Mathew JP, Brennan JM, et al. Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database. Eur J Cardiothorac Surg. 2017 Sep 1;52(3):492–8.
Englum, Brian R., et al. “Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database.Eur J Cardiothorac Surg, vol. 52, no. 3, Sept. 2017, pp. 492–98. Pubmed, doi:10.1093/ejcts/ezx133.
Englum BR, He X, Gulack BC, Ganapathi AM, Mathew JP, Brennan JM, Reece TB, Keeling WB, Leshnower BG, Chen EP, Jacobs JP, Thourani VH, Hughes GC. Hypothermia and cerebral protection strategies in aortic arch surgery: a comparative effectiveness analysis from the STS Adult Cardiac Surgery Database. Eur J Cardiothorac Surg. 2017 Sep 1;52(3):492–498.
Journal cover image

Published In

Eur J Cardiothorac Surg

DOI

EISSN

1873-734X

Publication Date

September 1, 2017

Volume

52

Issue

3

Start / End Page

492 / 498

Location

Germany

Related Subject Headings

  • United States
  • Survival Rate
  • Risk Factors
  • Respiratory System
  • Incidence
  • Humans
  • Hospital Mortality
  • Databases, Factual
  • Circulatory Arrest, Deep Hypothermia Induced
  • Cerebrovascular Circulation