Abstract：
OBJECTIVE: New temperature management concepts of moderate and mild hypothermic circulatory arrest during aortic arch surgery have gained weight over profound cooling. Comparisons of all temperature levels have rarely been performed. We performed direct and indirect comparisons of deep hypothermic circulatory arrest (DHCA) (≤20°C), moderate hypothermic circulatory arrest (MHCA) (20.1-25°C), and mild hypothermic circulatory arrest (mild HCA) (≥25.1°C) in a network meta-analysis.
METHODS: The literature was systematically searched for all papers published through February 2022 reporting on clinical outcomes after aortic arch surgery utilizing DHCA, MHCA and mild HCA. The primary outcome was operative mortality. The secondary outcomes were postoperative stroke and acute kidney failure (AKI).
RESULTS: A total of 34 studies were included, with a total of 12,370 patients. DHCA was associated with significantly higher postoperative incidence of stroke when compared with MHCA (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.19-1.78) and mild HCA: (OR, 1.50, 95% CI, 1.14-1.98). Furthermore, DHCA and MHCA were associated with higher operative mortality when compared with mild HCA (OR 1.71, 95% CI, 1.23-2.39 and OR 1.50, 95% CI, 1.12-2.00, respectively). Separate analysis of randomized and propensity score matched studies showed sustained increased risk of stroke with DHCA in contrast to MHCA and mild HCA (OR, 1.61, 95% CI, 1.18-2.20, p value = .0029 and OR, 1.74, 95% CI, 1.09-2.77, p value = .019).
CONCLUSIONS: In the included studies, the moderate to mild hypothermia strategies were associated with decreased operative mortality and the risk of postoperative stroke. Large-scale prospective studies are warranted to further explore appropriate temperature management for the treatment of aortic arch pathologies.
METHODS: The literature was systematically searched for all papers published through February 2022 reporting on clinical outcomes after aortic arch surgery utilizing DHCA, MHCA and mild HCA. The primary outcome was operative mortality. The secondary outcomes were postoperative stroke and acute kidney failure (AKI).
RESULTS: A total of 34 studies were included, with a total of 12,370 patients. DHCA was associated with significantly higher postoperative incidence of stroke when compared with MHCA (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.19-1.78) and mild HCA: (OR, 1.50, 95% CI, 1.14-1.98). Furthermore, DHCA and MHCA were associated with higher operative mortality when compared with mild HCA (OR 1.71, 95% CI, 1.23-2.39 and OR 1.50, 95% CI, 1.12-2.00, respectively). Separate analysis of randomized and propensity score matched studies showed sustained increased risk of stroke with DHCA in contrast to MHCA and mild HCA (OR, 1.61, 95% CI, 1.18-2.20, p value = .0029 and OR, 1.74, 95% CI, 1.09-2.77, p value = .019).
CONCLUSIONS: In the included studies, the moderate to mild hypothermia strategies were associated with decreased operative mortality and the risk of postoperative stroke. Large-scale prospective studies are warranted to further explore appropriate temperature management for the treatment of aortic arch pathologies.
摘要：
目的：主动脉弓手术期间中度和轻度低温循环骤停的新温度管理概念比深度降温增加了体重。很少进行所有温度水平的比较。我们进行了深低温停循环（DHCA）（≤20°C）的直接和间接比较，中度低温停循环（MHCA）（20.1-25°C），网络荟萃分析中的轻度低温停循环（轻度HCA）（≥25.1°C）。
方法：系统检索了2022年2月发表的所有报告使用DHCA进行主动脉弓手术后临床结果的论文，MHCA和轻度HCA。主要结果是手术死亡率。次要结果是术后卒中和急性肾衰竭（AKI）。
结果：共纳入34项研究，共有12370名患者。与MHCA相比，DHCA与术后卒中发生率显著升高相关(比值比[OR]，1.46，95%置信区间[CI]，1.19-1.78)和轻度HCA：(或，1.50，95%CI，1.14-1.98）。此外，与轻度HCA相比，DHCA和MHCA的手术死亡率较高（OR分别为1.71，95％CI，1.23-2.39和OR1.50，95％CI，1.12-2.00）。对随机和倾向评分匹配研究的单独分析显示，与MHCA和轻度HCA相比，DHCA的卒中风险持续增加（OR，1.61，95%CI，1.18-2.20，p值=.0029，OR，1.74，95%CI，1.09-2.77，p值=0.019）。
结论：在纳入的研究中，中度至轻度低温治疗策略与降低手术死亡率和术后卒中风险相关.有必要进行大规模的前瞻性研究，以进一步探索治疗主动脉弓病变的适当温度管理。
方法：系统检索了2022年2月发表的所有报告使用DHCA进行主动脉弓手术后临床结果的论文，MHCA和轻度HCA。主要结果是手术死亡率。次要结果是术后卒中和急性肾衰竭（AKI）。
结果：共纳入34项研究，共有12370名患者。与MHCA相比，DHCA与术后卒中发生率显著升高相关(比值比[OR]，1.46，95%置信区间[CI]，1.19-1.78)和轻度HCA：(或，1.50，95%CI，1.14-1.98）。此外，与轻度HCA相比，DHCA和MHCA的手术死亡率较高（OR分别为1.71，95％CI，1.23-2.39和OR1.50，95％CI，1.12-2.00）。对随机和倾向评分匹配研究的单独分析显示，与MHCA和轻度HCA相比，DHCA的卒中风险持续增加（OR，1.61，95%CI，1.18-2.20，p值=.0029，OR，1.74，95%CI，1.09-2.77，p值=0.019）。
结论：在纳入的研究中，中度至轻度低温治疗策略与降低手术死亡率和术后卒中风险相关.有必要进行大规模的前瞻性研究，以进一步探索治疗主动脉弓病变的适当温度管理。
