Objective

Our objective is to determine if moderate hypothermic circulatory arrest; MHCA (20.1-28.0°C) combined with antegrade cerebral perfusion independently predict post-operative outcomes and blood products usage compared to deep hypothermic circulatory arrest; DHCA (14.1-20.0°C) in elective aortic arch reconstruction surgery.

Methods

An electronic search was performed on 6 databases. Comparison studies on deep versus moderate hypothermic circulatory arrest with antegrade cerebral perfusion reporting in-hospital mortality, end-organ protections such as neurological dysfunction, stroke risk, renal failures; post-operative bleeding, duration of operation, and blood products use were included. Meta-analysis on the effect size, t-test, i2 heterogeneity test, and forest plot assessing the relative impact of each study was performed.

Results

5 studies with 1581 patients of whom 473 had undergone MHCA met the inclusion criteria. The mean aortic reconstruction time=25 mins. Pooled analysis showed that in-hospital mortality is significantly higher in DHCA (RR=2.40; p=0.007). The incidence of new onset stroke (RR=3.61; p=0.01), red blood cells transfusion (+0.45 units, p=0.03), and CBT time (+45 mins, p<0.00001) are also increased in DHCA. No significant different was detected in renal failure, reop for bleeding, neurological events.

Conclusion

MHCA with antegrade cerebral perfusion adapted to circulatory arrest time significantly reduces in-hospital mortality, cardiopulmonary bypass time, stroke rate and transfusion requirement compared to deep hypothermia for elective open aortic arch surgery.