• James A Brown, Zihan Feng, Shwetabh Tarun, Veenah Stoll, Derek Serna-Gallegos, Irsa Hasan, Takuya Ogami, Floyd Thoma, Jianhui Zhu, Kathirvel Subramaniam, Julie Phillippi, and Ibrahim Sultan.
• Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, PA.
• J. Cardiothorac. Vasc. Anesth. 2025 Jan 6.

ObjectiveTo determine the impact of hematocrit on adverse neurologic events after acute type A aortic dissection (ATAAD) repair under deep hypothermic circulatory arrest.DesignRetrospective study of consecutive aortic surgeries from 2010 to 2021.SettingSingle institution.ParticipantsPatients undergoing open ATAAD repairs, excluding those with preoperative cerebral malperfusion syndrome (defined as neurologic deficit with radiographic evidence of cerebral branch vessel malperfusion).InterventionsPatients were split into three groups: normal, low, and high hematocrit.Measurements & Main ResultsA total of 527 patients were included, of which 355 (67.3%) had normal hematocrit, 143 (27.1%) had low hematocrit, and 29 (5.5%) had high hematocrit. Overall, 20 (3.8%) patients had a postoperative stroke, which was comparable across groups (p = 0.59). Patients with normal hematocrit had lower in-hospital mortality (p = 0.02) and lower transfusion rates (p < 0.001), while re-exploration for bleeding was similar across groups (p = 0.68). After multivariable adjustment, there was no association between hematocrit and postoperative stroke (odds ratio [OR]: 1.00, 95% confidence interval [CI]: 0.99, 1.00, p = 0.79). Compared with normal hematocrit, there was no association between low hematocrit (OR: 1.59, 95% CI: 0.77, 3.28, p = 0.21) or high hematocrit (OR: 2.48, 95% CI: 0.74, 8.29, p = 0.14) and in-hospital mortality.ConclusionsPreoperative hematocrit was not associated with stroke or mortality after ATAAD repair. The rheologic effect of hematocrit on cerebral perfusion under deep hypothermia may be minimal.Copyright © 2025 Elsevier Inc. All rights reserved.

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