Abstract：
OBJECTIVE: The optimal core temperature for hypothermic circulatory arrest during aortic arch surgery remains contentious. This study aims to evaluate patient outcomes under various temperatures within a large single-centre cohort.
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.
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.
摘要：
目的：主动脉弓手术期间低温停循环的最佳核心温度仍然存在争议。本研究旨在评估大型单中心队列中各种温度下的患者预后。
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。
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。
