Abstract
Background: The objective of this study was to compare the incidence of severe systemic inflammatory response syndrome (sSIRS) after total aortic arch replacement between patients who underwent moderate hypothermic circulatory arrest (MHCA) and those who underwent deep hypothermic circulatory arrest (DHCA).Methods: At Fuwai Hospital, 600 patients who underwent total aortic arch replacement with MHCA or DHCA from January 2013 to December 2016 were consecutively enrolled and divided into DHCA (14.1–20.0°C) and MHCA (20.1–28.0°C) groups. Preliminary statistical analysis revealed that some baseline indicators differed between the two groups; therefore, propensity score matching (PSM) was used to balance the covariates. Post-operative sSIRS as the primary outcome was compared between the groups both before and after PSM.Results: A total of 275 (45.8%) patients underwent MHCA, and 325 (54.2%) patients underwent DHCA. After PSM analysis, a total of 191 matched pairs were obtained. The overall incidence of sSIRS was 27.3%. There was no significant difference in post-operative sSIRS between the MHCA group and the DHCA group in either the overall cohort or the PSM cohort (no-PSM: P = 0.188; PSM: P = 0.416); however, post-operative sSIRS was increased by ~4% in the DHCA group compared with the MHCA group in both the no-PSM and PSM cohorts (no-PSM: 29.5 vs. 24.7%; PSM: 29.3 vs. 25.1%). Both before and after PSM, the rates of gastrointestinal hemorrhage and pulmonary infection and post-operative length of stay were significantly increased in the DHCA group compared with the MHCA group (P < 0.05), and the remaining secondary outcomes were not significantly different between the groups.Conclusions: MHCA and DHCA are associated with comparable incidences of sSIRS in patients following total aortic arch replacement for type A aortic dissection. However, the MHCA group had a shorter cardiopulmonary bypass time, a shorter post-operative length of stay and lower pulmonary infection and gastrointestinal hemorrhage rates than the DHCA group. We cautiously recommend the use of MHCA for most total arch replacements in patients with type A aortic dissection.
Highlights
Post-operative systemic inflammatory response syndrome (SIRS) significantly increases morbidity, such as multiorgan failure, and even mortality [1, 2]
The objective of our study was to compare the incidence of systemic inflammatory response syndrome (sSIRS) between patients who underwent moderate hypothermic circulatory arrest (MHCA) and those who underwent deep hypothermic circulatory arrest (DHCA), and we expected the other baseline variables to be balanced between the two groups
The rate of gastrointestinal hemorrhage, rate of pulmonary infection and post-operative length of stay were significantly increased in the DHCA group compared with the MHCA group both before and after propensity score matching (PSM) (P < 0.05), but the remaining secondary outcomes were not significantly different between the groups either before or after PSM
Summary
Post-operative systemic inflammatory response syndrome (SIRS) significantly increases morbidity, such as multiorgan failure, and even mortality [1, 2]. Several factors, such as surgical trauma, blood contact with non-endothelial surfaces that leads to activation of the coagulation/complement cascade, ischemiareperfusion, endotoxemia, hypothermia, blood transfusion, heparin and protamine, contribute to the development of SIRS after cardiac surgery with cardiopulmonary bypass [3,4,5]. The objective of this study was to compare the incidence of severe systemic inflammatory response syndrome (sSIRS) after total aortic arch replacement between patients who underwent moderate hypothermic circulatory arrest (MHCA) and those who underwent deep hypothermic circulatory arrest (DHCA)
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