METHODS: Between 2010 and 2018, patients diagnosed with type A aortic dissection underwent total arch replacement at Fuwai Hospital were enrolled. They were categorized into 4 groups: deep hypothermia group, low-moderate hypothermia group, high-moderate hypothermia group and mild hypothermia group. Clinical data were analysed to ascertain differences between the groups.
RESULTS: A total of 1310 patients were included in this cohort. Operative mortality stood at 6.9% (90/1310), with a higher incidence observed in the deep hypothermia group [29 (12.9%); 35 (6.9%); 21 (4.8%); 5 (3.4%); all adjusted P < 0.05]. Overall 10-year survival was 80.3%. Long-term outcomes did not significantly differ among the groups. Multivariable logistic analysis revealed a protective effect of higher core temperature on operative mortality (odds ratio 0.848, 95% confidence interval 0.766-0.939; P = 0.001). High-moderate hypothermia emerged as an independent protective factor for operative mortality (odds ratio 0.303, 95% confidence interval 0.126-0.727; P = 0.007). Multivariable Cox analysis did not detect an effect of hypothermic circulatory arrest on long-term survival (all P > 0.05).
CONCLUSIONS: High-moderate hypothermia (24.1-28°C) offers the most effective protection against surgical mortality and is therefore recommended. Different hypothermic circulatory arrest temperatures do not influence long-term survival or quality of life.
方法:2010年至2018年,阜外医院诊断为A型主动脉夹层的患者接受了全弓置换术。他们分为四组:深低温组,低-中度低温组,高-中度低温组,和亚低温组。分析临床数据以确定组间的差异。
结果:共有1310名患者被纳入该队列。手术死亡率为6.9%(90/1310),在深低温组中观察到更高的发生率[29(12.9%);35(6.9%);21(4.8%);5(3.4%);所有校正P<0.05]。10年总生存率为80.3%。两组之间的长期结果没有显着差异。多变量逻辑分析显示,较高的核心温度对手术死亡率有保护作用(比值比0.848,95%置信区间0.766-0.939;P=0.001)。高-中度低温是手术死亡率的独立保护因素(比值比0.303,95%置信区间0.126-0.727;P=0.007)。多变量Cox分析未发现低温停循环对长期生存的影响(均P>0.05)。
结论:高-中度低温(24.1-28°C)对手术死亡率提供了最有效的保护,因此值得推荐。不同的低温停循环温度不会影响长期生存或生活质量。