• Yuan Xue, Yeting Lou, Shipan Wang, Yazhe Zhang, Xiaomeng Wang, Xuehuan Zhang, Yue Shi, Youjin Li, Haiping Yang, Hongli Li, Gang Liu, Minjia Zhu, Jian Huang, Qingwu Zhao, Jihong Liu, Haibo Wu, Duanduan Chen, Wenjian Jiang, Hongjia Zhang, and Haiyang Li.
• Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China,; Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing 100029, China,; Beijing Lab for Cardiovascular Precision Medicine, Beijing 100029, China.
• J. Thorac. Cardiovasc. Surg. 2024 Dec 4.

BackgroundThe optimal hypothermic circulatory arrest (HCA) temperature during total arch replacement (TAR) and the impact of HCA temperature on postoperative neurological complications are still uncertain.ObjectiveThe aim of this study is to explore the impact of HCA temperature on short-term postoperative outcomes, especially neurological complications, for patients who undergo TAR.MethodsWe retrospectively analyzed data of 2351 patients who underwent TAR at one of seven selected aortic centers from January 2016 to June 2023. Restricted cubic splines (RCS) and subgroup analyses were performed to determine the relation between temperature and outcomes under different cerebral perfusion methods, cannulation strategies, diagnoses, and surgical timings.ResultsThe overall in-hospital mortality was 6.2% (n = 146). The incidence of stroke, paraplegia and total-arch composite outcome (TCO) was 6.0% (n = 142), 2.8% (n = 65) and 21.0% (n = 494), respectively. The average HCA temperature was 25.9 ± 1.9 °C, and the median circulatory arrest time was 23 (Q1, Q3: 18, 30) min. Adjusted RCS showed the lowest incidence of stroke, paraplegia, and TCO at temperatures of 26.6 °C, 27.4 °C, and 26.8 °C, but without statistical significance. In subgroup analysis, the unilateral antegrade cerebral perfusion (uACP) group revealed a significant nonlinear relation between HCA temperature and the risk of stroke, and the lowest risk showed at 26.5 °C. Other subgroup analyses did not reveal a significant nonlinear relation between temperature and outcomes.ConclusionsFor patients undergoing TAR with uACP, cooling to a temperature of 26-27 °C was associated with the lowest incidence of stroke.Copyright © 2024. Published by Elsevier Inc.

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