Hypothermic Circulatory Arrest With Moderate Hypothermic During Aortic Arch Surgery

Objective: To discuss the safety of mild hypothermic(25~28℃) cardiac arrest in aortic dissection surgery treatment, compared with moderate hypothermic(20~25℃) cardiac arrest.Methods: A review of clinical material of 80 Stanford type A aortic dissection patients who underwent aortic arch replacement between June 2011 and December 2015 at 2nd hospital of Jilin University. 40 patients underwent aortic arch replacement at temperatures between 20℃ to 25℃. 40 patients underwent aortic arch replacement at temperatures between 25℃ to 28℃. Preoperative demographics, operation time, cardiopulmonary bypass time, cross-clamp time, circulatory arrest time, cooling time, rewarming time, operating method, length of stay in hospital, post-op comatose time, incidence of chemosis, incidence of post-op restlessness, time with tube, Sp O2 after removing tube, incidence of tracheotomy, incidence of retubed, incidence of CRRT, ALT, AST, TBIL, Cre, and length of stay in ICU were assessed. Get conclusion by analyzing outcomes.Results: No statistical differences were found in the percentage of male, age, weight, EF, incidence of hypertension, incidence of diabetes mellitus, pre-op ALT, pre-op AST, pre-op TBIL, pre-op Cre, and operating method. The operation time of moderate hypothermic group is(384.0±64.8) min. The cardiopulmonary bypass time, of moderate hypothermic group is(180.0±26.4) min. The cross-clamp time of moderate hypothermic group is(125.6±24.9) min. The circulatory arrest time moderate hypothermic group is(41.3±11.4) min. The cooling time of moderate hypothermic group is(51.9±10.7) min. The rewarming time of moderate hypothermic group is(66.2±10.3) min. The operation time of mild hypothermic group is(406±95.0) min. The cardiopulmonary bypass time of mild hypothermic group is(160.5±34.7) min. The cross-clamp time of mild hypothermic group is(110.5±27.4) min. The circulatory arrest time of mild hypothermic group is(39.7±7.2) min. The cooling time of mild hypothermic group is(29.3±9.9) min. The rewarming time of mild hypothermic group is(59.7±6.9) min. Operation time, circulatory arrest time and post-op comatose time were equivalent between mild hypothermic and moderate hypothermic groups. The differences of cardiopulmonary bypass time, cross-clamp time, cooling time, and rewarming time between two groups were statistically significant. 20 patients of mild hypothermic group underwent chemosis after operation,while 7 patients of moderate hypothermic group did. 13 patients of mild hypothermic group underwent post-op restlessness after operation, while 4 patients of moderate hypothermic group did. Compared with the moderate hypothermic group, the incidence of chemosis and the incidence of post-op restlessness of mild hypothermic group reduced. The differences between two groups were statistically significant. The time with tube of moderate hypothermic group was(5.4±2.5) d, while the time with tube of mild hypothermic group was(3.5±2.3) d. The time with tube of mild hypothermic group was lower than the time with tube of moderate hypothermic group and the difference between two groups was statistically significant. Sp O2 after removing tube of two groups were familiar and the difference between two groups was statistically significant. Incidence of tracheotomy, incidence of retubed, pre-op ALT, pre-op AST, pre-op TBIL, pre-op Cre, incidence of CRRT and death of two groups were familiar and the differences between two groups were statistically significant. The length of stay in ICU of moderate hypothermic group was(9.7±5.0) d, while the length of stay in ICU of mild hypothermic group was(6.8±5.9) d. The length of stay in hospital of moderate hypothermic group was(26.0±12.3) d, while the length of stay in hospital of mild hypothermic group was(20.1±7.6) d. The length of stay in ICU and the length of stay in hospital of mild hypothermic group were less than those of moderate hypothermic group and the differences between two groups were statistically significant.Conclusion: Compared with moderate hypothermic(20~25℃), mild hypothermic(25~28℃) applied during circulatory arrest doesn‘t increase incidences of kidney injury, liver injury, respiratory insufficiency, and cerebral injury.