Association Between Rewarming Rate and Short-term Outcomes After Repair of DeBakey Type I Acute Aortic Dissection: A Propensity Score-matched Analysis.

OBJECTIVES

To evaluate the association between rewarming rate and short-term postoperative outcomes after repair of DeBakey type I acute aortic dissection (AAD).

METHODS

From January 2019 to November 2023, 763 patients with DeBakey type I AAD undergoing total arch replacement (TAR) and the frozen elephant trunk (FET) procedure were enrolled. Patients were categorized into 3 groups according to bladder rewarming rate: high (≥0.5°C/min), medium (0.2-0.5°C/min), and low (≤0.2°C/min). Propensity score matching (PSM) was applied to balance baseline characteristics, and short-term postoperative outcomes were compared across groups.

RESULTS

After PSM, the incidence of short-term death differed significantly across the 3 bladder rewarming rate groups (overall P value = .021). Pairwise comparisons showed a higher incidence of short-term death in the ≥0.5°C/min group compared with the 0.2-0.5°C/min group (Holm-adjusted P value = .041), whereas no significant differences were observed between other pairs. No significant differences were found in other major short-term postoperative outcomes.

CONCLUSIONS

In patients with DeBakey type I AAD who undergo TAR and FET procedure, faster bladder rewarming (at ≥0.5°C/min) may increase the risk of short-term death, whereas slower rewarming (at ≤0.2°C/min) does not appear to adversely affect early postoperative outcomes. These findings should be interpreted with caution and underscore the need for further prospective investigation to define optimal rewarming strategies.