Randomized controlled trial of moderate hypothermia versus deep hypothermia anesthesia on brain injury during Stanford A aortic dissection surgery

Sun, Xufang; Yang, Hua; Li, Xinyu; Wang, Yue; Zhang, Chuncheng; Zhang, Song; Pan, Zhenxiang

doi:10.1007/s00380-017-1037-9

Cited by 12 publications

(10 citation statements)

References 18 publications

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“…Emergency surgeries, including aortic dissection, are essentially an independent risk factors which contributes to poorer outcomes. 44,45 Thus, a true comparison could not be made in our study due to difference in aortic pathologies.…”

Section: Discussionmentioning

confidence: 94%

Neuroprotective strategies with circulatory arrest in open aortic surgery – A meta-analysis

Manoly¹,

Uzzaman²,

Karangelis

et al. 2022

Asian Cardiovasc Thorac Ann

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Objective Deep hypothermic circulatory arrest (DHCA) in aortic surgery is associated with morbidity and mortality despite evolving strategies. With the advent of antegrade cerebral perfusion (ACP), moderate hypothermic circulatory arrest (MHCA) was reported to have better outcomes than DHCA. There is no standardised guideline or consensus regarding the hypothermic strategies to be employed in open aortic surgery. Meta-analysis was performed comparing DHCA with MHCA + ACP in patients having aortic surgery. Methods A systematic review of the literature was undertaken. Any studies with DHCA versus MHCA + ACP in aortic surgeries were selected according to specific inclusion criteria and analysed to generate summative data. Statistical analysis was performed using STATS Direct. The primary outcomes were hospital mortality and post-operative stroke. Secondary outcomes were cardiopulmonary bypass time (CPB), post-operative blood transfusion, length of ICU stay, respiratory complications, renal failure and length of hospital stay. Subgroup analysis of primary outcomes for Arch surgery alone was also performed. Results Fifteen studies were included with a total of 5869 patients. There was significantly reduced mortality (Pooled OR = +0.64, 95% CI = +0.49 to +0.83; p = 0.0006) and stroke rate (Pooled OR = +0.62, 95% CI = +0.49 to +0.79; p < 0.001) in the MHCA group. MHCA was associated significantly with shorter CPB times, shorter duration in ICU, less pulmonary complications, and reduced rates of sepsis. There was no statistical difference between the two groups in terms of circulatory arrest times, X-Clamp times, total operation duration, transfusion requirements, renal failure and post-op hospital stay. Conclusion MHCA + ACP are associated with significantly better post-operative outcomes compared with DHCA for both mortality and stroke and majority of the secondary outcomes.

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Section: Discussionmentioning

confidence: 94%

Neuroprotective strategies with circulatory arrest in open aortic surgery – A meta-analysis

Manoly¹,

Uzzaman²,

Karangelis

et al. 2022

Asian Cardiovasc Thorac Ann

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show abstract

“…Then a preliminary screening was made by reading titles and abstracts, and next the full texts were downloaded and assessed for eligibility. Eleven studies [21][22][23][24][25][26][27][28][29][30][31] were finally included. Search flow diagram of the present meta-analysis was depicted in Figure 1.…”

Section: Search Resultsmentioning

confidence: 99%

“…Three studies were multicentric 22,25,31 and four only included aortic dissection patients. 21,26,28,29 Four studies 21,26,29,30 reported the two groups had the same surgeons, and six 21,22,[24][25][26]30 showed the surgical techniques were similar in the two groups.…”

Section: Study Characteristicsmentioning

confidence: 99%

Clinical outcomes of mild versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in adult aortic arch surgery: A systematic review and meta-analysis

Wang

Zhong

et al. 2022

Perfusion

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Objectives In adult aortic arch surgery, moderate hypothermic circulatory arrest (HCA) with selective antegrade cerebral perfusion (SACP) (MoHACP) is widely used, but the application of mild HCA with SACP (MiHACP) is still controversial. This meta-analysis aimed to compare clinical outcomes using MiHACP or MoHACP. Methods Studies comparing outcomes of MiHACP or MoHACP in adult aortic arch surgery were searched from four databases from inception through April 2022. Primary outcomes were postoperative permanent neurological deficit (PND), temporary neurological deficit (TND), and mortality. Secondary outcomes included other common complications. Meta-analysis was conducted using a random-effects model in all cases. Results Eleven comparative studies were included, with 1555 patients in MiHACP group and 1499 patients in MoHACP group, and the mean HCA temperature were 29.4°C and 24.8°C, respectively. Postoperative PND, TND, mortality, paraplegia, dialysis, tracheotomy, reexploration for bleeding, and chest tube drainage volume were comparable in the two groups ( p > 0.05). Ventilator time, intensive care unit and in-hospital length of stay were shorter in MiHACP group ( p < 0.05). Outcomes were also comparable or had some benefits in MiHACP group when subgroup analyses were conducted according to hemiarch or total arch replacement, unilateral or bilateral SACP, HCA time, emergency aortic dissection surgery, and concomitant procedure. Conclusion The present meta-analysis showed acceptability of MiHACP in adult aortic arch surgery. Results need to be taken with caution as moderate risk of bias and very low quality of evidence were observed in this meta-analysis. Randomized controlled trials are needed for further analysis.

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“…Recently, moderate hypothermia (MH) (25-28 C) due to anesthesia has been encouraged by some scholars. 18,19 Future studies should investigate if MH is better for the reduction of the risk of neurological disorders and other complications than DH in this type of population. No neurological complications occurred in this patient case after 6 months of follow-up.…”

Section: Perioperative Management For High-altitude Inhabitantsmentioning

confidence: 99%

Anesthesia of a high-altitude area inhabitant who underwent aortic dissection emergency surgery in a low-altitude area

Zheng

Wei

et al. 2020

J Int Med Res

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Heart surgery in patients from high-altitude areas is more challenging than usual. Few studies have been published on this issue, and none of them have discussed the effect of an altitude change (from high to low altitude) on a patient’s physiology or its effects on a patient’s perioperative management. Here, we present the case of a 46-year-old man who was a long-time resident of Tibetan area in Sichuan (altitude >3000 m) who underwent Stanford type A aortic dissection emergency surgery on the plain. Anesthetic management occurred through monitoring of the bispectral index (BIS) and transesophageal echocardiography (TEE), and we used a relatively loose fluid hydration strategy. The surgery was performed using cardiopulmonary bypass (CPB), deep hypothermia (DH), and selective antegrade cerebral perfusion. The most prominent anesthesia challenges for these patients are physiological changes due to habitation in an high-altitude environment (chronic hypoxemia), which can cause hyperhemoglobinemia, polycythemia, hypercoagulable blood, and even pulmonary hypertension, cor pulmonale, or congestive heart failure. Optimized perioperative management and close cooperation among the entire cardiac medical team were the key factors in the successful management of this rare case.

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Randomized controlled trial of moderate hypothermia versus deep hypothermia anesthesia on brain injury during Stanford A aortic dissection surgery

Cited by 12 publications

References 18 publications

Neuroprotective strategies with circulatory arrest in open aortic surgery – A meta-analysis

Neuroprotective strategies with circulatory arrest in open aortic surgery – A meta-analysis

Clinical outcomes of mild versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion in adult aortic arch surgery: A systematic review and meta-analysis

Anesthesia of a high-altitude area inhabitant who underwent aortic dissection emergency surgery in a low-altitude area

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