Effect of lower-body ischemia duration in aortic arch surgery under mild-to-moderate hypothermic circulatory arrestCentral MessagePerspective
Giacomo Murana, MD,
Chiara Nocera, MD,
Luca Zanella, MD,
Luca Di Marco, MD,
Silvia Snaidero, MD,
Sabrina Castagnini, MD,
Carlo Mariani, MD,
Davide Pacini, MD, PhD
Affiliations
Giacomo Murana, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Address for reprints: Giacomo Murana, MD, Division of Cardiac Surgery, Cardio-Thoraco-Vascular Department, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant’Orsola, Via Massarenti 9, Bologna, 40138, Italy.
Chiara Nocera, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Luca Zanella, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy
Luca Di Marco, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy
Silvia Snaidero, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Sabrina Castagnini, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Carlo Mariani, MD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
Davide Pacini, MD, PhD
Division of Cardiac Surgery, Cardiac Surgery Department, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, DIMEC, Alma Mater Studiorum-University of Bologna, Bologna, Italy
Objectives: Aortic arch surgery is performed at increasingly higher circulatory arrest temperatures. This might affect visceral protection. We analyzed the effect of visceral ischemic time in arch surgery under mild-to-moderate hypothermia. Methods: We divided the population into 3 groups: group 1 (visceral ischemic time ≤30 minutes), group 2 (31-60 minutes), and group 3 (>60 minutes). The link between visceral ischemic times and in-hospital outcomes, and visceral function biomarker levels were retrospectively analyzed through chi-square test, nonparametric analysis of variance, and cubic spline interpolation. Results: From 1995 to 2023, 1325 patients underwent aortic arch surgery under circulatory arrest at our center. Mild-to-moderate hypothermia (nasopharyngeal temperature ≥25°) was used in 960 cases. There was no significant difference among the groups for in-hospital death (group 1 = 8.5%, group 2 = 13.2%, group 3 = 11.3%; P = .224), renal complications (group 1 = 13.0%, group 2 = 19.7%, group 3 = 22.6%; P = .056), and gastrointestinal complications (group 1 = 5%, group 2 = 5.5%, group 3 = 7.1%; P = .696). However, respiratory complications (group 1 = 19.4%, group 2 = 28.1%, group 3 = 21.4%; P = .027) and transient dialysis (group 1 = 2.8%, group 2 = 7.8%, group 3 = 11.3%; P = .011) were linked to longer visceral ischemic times. Groups 2 and 3 presented significantly higher levels of creatinine (P < .01), glutamic-oxaloacetic transaminase (P < .05), and glutamic pyruvic transaminase (24 and 48 hours postsurgery, P < .01). Cubic spline analysis showed that the incidence of renal complications reached a minimum at a low visceral ischemic time and then consistently increased. Respiratory complications showed a maximum incidence at approximately 50 minutes of visceral ischemic time and then subsequently decreased. Conclusions: Mild-to-moderate hypothermia is a safe strategy for visceral organ protection regardless of visceral ischemic time. However, longer visceral ischemic times are linked to renal complications.
