Impact of hypothermia level on neurological and renal outcomes in emergency aortic surgery: a single-centre experience
Justine Tin Nok Chan, Ibrahim Talal Fazmin, Ismail Vokshi, Ravi de Silva, Shakil FaridBackground
Temperature management during emergency surgery for acute aortic syndrome is critical for neurological, renal, and systemic protection. Recent European Association for Cardio-Thoracic Surgery (EACTS) guidelines recommend moderate hypothermia with antegrade cerebral perfusion for hemiarch procedures. Nevertheless, deep hypothermic circulatory arrest (DHCA) remains common. This study evaluates neurological and other postoperative outcomes across different intraoperative temperature ranges.
Methods
A single-centre retrospective study of consecutive patients undergoing surgery for acute aortic syndrome between 2018–2023. Demographic, intraoperative, and postoperative data on mortality, hospitalization, neurological, renal outcomes, and blood product usage were collected. Patients were stratified by intraoperative temperature: deep (≤20°C), low-moderate (20.1–24°C), high-moderate (24.1–28°C), and mild (>28°C) hypothermia. Logistic regression identified predictors of binary adverse outcomes. A sensitivity analysis was conducted using 24.0°C as the threshold in hemiarch surgery patients.
Results
A total of 175 patients (median age 64 years; 37% female) were included; of whom 89% underwent hemiarch replacement. Cardiopulmonary bypass duration decreased progressively with warmer intraoperative temperatures, ranging from 270.5 minutes in deep hypothermia to 164 minutes in mild hypothermia. The 30-day mortality was 18.9% (
Discussion
Our findings support current EACTS recommendations favouring moderate-to-mild hypothermia for hemiarch replacement, with potential protective effects. Further studies should determine the optimal temperature strategy for patients undergoing total arch replacement.