Journal of thoracic disease · 2026
Application of mild hypothermic arch-clamping technique in the repair of DeBakey type I aortic dissection.
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Luo Cheng, Cai Xiongwei, Fang Chen, Li Yugui, Peng Jun, Lu Wei, Zheng Baoshi
Аннотация
BACKGROUND: Acute DeBakey type I aortic dissection is a life-threatening cardiovascular emergency with high morbidity and mortality, often requiring total arch replacement. This study aimed to evaluate the safety and efficacy of mild hypothermic arch-clamping technique in the surgical treatment of DeBakey type I aortic dissection.
METHODS: A total of 307 patients with DeBakey type I aortic dissection who underwent arch-clamping technique at The First Affiliated Hospital of Guangxi Medical University from January 2020 to December 2024 were retrospectively analyzed from a prospectively maintained database. According to the lowest rectal temperature during circulatory arrest, patients were divided into mild hypothermia group (122 cases, 28.1-34 ℃) and moderate hypothermia group (185 cases, 20.1-28 ℃). Perioperative indicators were compared. The composite outcome including 30-day death, stroke, paraplegia, and continuous renal replacement therapy (CRRT) was the primary endpoint. Multivariate logistic regression with forced entry of clinically important variables was used to identify risk factors. Long-term survival and reintervention were evaluated by Kaplan-Meier method and Cox regression.
RESULTS: All 307 patients successfully completed the operation. The overall incidence of composite adverse outcomes was 18.9% (12.3% mild vs. 23.2% moderate, P=0.058). Stroke occurred in 4.1% vs. 6.5% (P=0.42). Cardiopulmonary bypass (CPB) time (145.2±31.5 vs. 161.8±35.2 min, P=0.03) and aortic cross-clamp time (87.6±22.4 vs. 98.3±26.1 min, P=0.04) were significantly shorter in the mild group; these differences persisted after excluding patients with concomitant coronary artery bypass grafting (CABG)/femoral bypass (P=0.03 and P=0.04, respectively). Multivariate regression (forced entry) showed that age [odds ratio (OR) =1.18, 95% confidence interval (CI): 1.03-1.35, P=0.02] and lactate (OR =1.82, 95% CI: 1.05-3.16, P=0.03) were independent risk factors for 30-day death; CPB time (OR =1.03, 95% CI: 1.01-1.06, P=0.02) was associated with CRRT. Circulatory arrest temperature group was not an independent predictor for any outcome (all P>0.05). Long-term follow-up (2.5±1.3 years) showed similar survival [92.6% vs. 88.7%, hazard ratios (HR) =0.52, 95% CI: 0.21-1.28, P=0.15] and reintervention rates (8.2% vs. 5.9%, HR =1.41, 95% CI: 0.48-4.12, P=0.53).
CONCLUSIONS: Mild hypothermic arch-clamping for DeBakey type I aortic dissection achieves satisfactory short- and long-term results. Compared with moderate hypothermia, it may shorten key surgical times and simplify the procedure without increasing adverse events, suggesting it is a safe and effective option for arch management.
METHODS: A total of 307 patients with DeBakey type I aortic dissection who underwent arch-clamping technique at The First Affiliated Hospital of Guangxi Medical University from January 2020 to December 2024 were retrospectively analyzed from a prospectively maintained database. According to the lowest rectal temperature during circulatory arrest, patients were divided into mild hypothermia group (122 cases, 28.1-34 ℃) and moderate hypothermia group (185 cases, 20.1-28 ℃). Perioperative indicators were compared. The composite outcome including 30-day death, stroke, paraplegia, and continuous renal replacement therapy (CRRT) was the primary endpoint. Multivariate logistic regression with forced entry of clinically important variables was used to identify risk factors. Long-term survival and reintervention were evaluated by Kaplan-Meier method and Cox regression.
RESULTS: All 307 patients successfully completed the operation. The overall incidence of composite adverse outcomes was 18.9% (12.3% mild vs. 23.2% moderate, P=0.058). Stroke occurred in 4.1% vs. 6.5% (P=0.42). Cardiopulmonary bypass (CPB) time (145.2±31.5 vs. 161.8±35.2 min, P=0.03) and aortic cross-clamp time (87.6±22.4 vs. 98.3±26.1 min, P=0.04) were significantly shorter in the mild group; these differences persisted after excluding patients with concomitant coronary artery bypass grafting (CABG)/femoral bypass (P=0.03 and P=0.04, respectively). Multivariate regression (forced entry) showed that age [odds ratio (OR) =1.18, 95% confidence interval (CI): 1.03-1.35, P=0.02] and lactate (OR =1.82, 95% CI: 1.05-3.16, P=0.03) were independent risk factors for 30-day death; CPB time (OR =1.03, 95% CI: 1.01-1.06, P=0.02) was associated with CRRT. Circulatory arrest temperature group was not an independent predictor for any outcome (all P>0.05). Long-term follow-up (2.5±1.3 years) showed similar survival [92.6% vs. 88.7%, hazard ratios (HR) =0.52, 95% CI: 0.21-1.28, P=0.15] and reintervention rates (8.2% vs. 5.9%, HR =1.41, 95% CI: 0.48-4.12, P=0.53).
CONCLUSIONS: Mild hypothermic arch-clamping for DeBakey type I aortic dissection achieves satisfactory short- and long-term results. Compared with moderate hypothermia, it may shorten key surgical times and simplify the procedure without increasing adverse events, suggesting it is a safe and effective option for arch management.