Normothermic Aortic Surgery as a Standard of Care in Type A Aortic Dissection

P0226 

Abstract Submission 

Laura Rings (1), Rasha Boulos (2), Vasileios Ntinopoulos (1), Achim Haeussler (2), Petar Risteski (2), Hector Rodriguez Cetina Biefer (2), Omer Dzemali (2)

(1) Department of Cardiac Surgery, City Hospital of Zurich – Site Triemli, Zurich, Switzerland, (2) Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland

Laura Rings    -  Contact Me
Department of Cardiac Surgery, City Hospital of Zurich – Site Triemli

Rasha Boulos    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Vasileios Ntinopoulos    -  Contact Me
Department of Cardiac Surgery, City Hospital of Zurich – Site Triemli

Achim Haeussler    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Petar Risteski    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Hector Rodriguez Cetina Biefer    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Omer Dzemali    -  Contact Me
Department of Cardiac Surgery, University Hospital Zurich

Laura Rings    -  Contact Me
Zurich Data Scientists GmbH

Objective: Acute type A aortic dissection remains a surgical challenge due to its inherited high risk for morbidity and mortality. Deep to moderate hypothermia is a standard for aortic surgery, such as aortic type A dissection. The current trend in aortic surgery is to avoid deep hypothermia due to possible deleterious effects. Early studies have shown the feasibility and safety of moderate to normothermic aortic surgery. Our institution has adopted normothermic surgery in type A aortic dissections. In this retrospective propensity score-matched analysis, we aim to set a new standard of care for patients undergoing surgery for acute type A aortic dissection.

Methods: A retrospective database analysis was performed for patients undergoing surgery for acute type A aortic dissections from January 2007 to January 2023 at a single center. Patients undergoing surgery in normothermia (> 35 °C) were matched with patients undergoing surgery in mild hypothermia (28 - 34 °C). Out of 218 patients, 20 propensity score-matched pairs were created. All patients were operated on using selective antegrade cerebral perfusion. Retrospective statistical analysis was performed regarding 30-day mortality, new neurological symptoms, and benefits in the intra and postoperative course (e.g., bypass time, need for transfusions).

Results: Our data shows very strong evidence favoring normothermia for lower extracorporeal bypass and cross-clamping times. Moreover, the normothermic group had a limited trend towards lower ICU stay (p = 0,59), intubation times (p = 0.4 ), and postoperative delirium (p = 0.1797). There was no evidence favoring hypothermia in terms of new neurological symptoms (n= 4 vs 6 in both groups; p =0.8), 30-day mortality (n = 3 vs. 1 patients, p = 0.6), blood transfusion (Erythrocytes and Thrombocytes) and Cell-Saver blood. A detailed breakdown of our results can be found on Table 1.

Conclusions: Normothermic surgery in acute type A aortic dissection reduces operation times, extracorporeal perfusion, and aortic cross-clamping that might be beneficial for the patients. Moreover, normothermic surgery is comparable to the current hypothermic standard in aortic dissection surgery, and does not affect early mortality.

Dissection