Newswise — Boston, MA (May 16, 2022) - Deep hypothermia has long been the standard for hypothermic circulatory arrest (HCA) during aortic arch surgery. Based on retrospective observational clinical data, many centers worldwide have shifted toward lesser degrees of hypothermia in conjunction with the use of selective antegrade cerebral perfusion (sACP). Given this lack of prospective comparative-effectiveness data, the optimal temperature for HCA remains unclear; and there have been increasing calls for a randomized controlled trial (RCT) to allow the development of evidence-based guidelines to define best practice.
Chad Hughes, MD, Director of the Duke Center for Aortic Disease, Durham, NC, says that “This study finally answers these calls and presents data from the first-ever multicenter prospective randomized controlled trial comparing clinical, neurocognitive, and imaging outcomes for the most commonly used hypothermia strategies in aortic arch surgery worldwide.”
The study aims were to determine impact of degree of hypothermia on neurocognitive function and quality of life and to determine impact of degree of hypothermia on brain volume and functional connectivity in regions critical to global cognition. It compared deep versus moderate hypothermia during HCA and included brain imaging/connectivity and neurological/neurocognitive outcomes.
From August 2016 to December 2022, 282 patients undergoing elective aortic arch surgery with HCA and sACP were enrolled in this study. They were randomly assigned to one of three groups with different hypothermia levels: Deep (<=20°C), low-moderate (20.1-24.0°C), and high-moderate (24.1-28.0°C).
Dr. Hughes will be presenting the data analysis of the one-month results today. This analysis will provide much needed objective data to help guide creation of evidence-based guidelines for optimal perfusion strategies in aortic arch surgery. “In addition,” says Dr. Hughes, “the trial outcomes will be unique in their inclusion of baseline and serial postoperative detailed imaging and functional neurocognitive assessments.”
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Presented by G. Chad Hughes, MD, May 16, 2022, at the AATS 102nd Annual Meeting
ABOUT THE AMERICAN ASSOCIATION FOR THORACIC SURGERY (AATS)
The American Association for Thoracic Surgery (AATS) is an international organization that encourages, promotes, and stimulates the scientific investigation of cardiothoracic surgery. Founded in 1917 by a respected group of the earliest pioneers in the field, its original mission was to “foster the evolution of an interest in surgery of the Thorax.” Today, the AATS is the premiere association for cardiothoracic surgeons in the world and works to continually enhance the ability of cardiothoracic surgeons to provide the highest quality of patient care. Its more than 1,500 members have a proven record of distinction within the specialty and have made significant contributions to the care and treatment of cardiothoracic disease. Visit www.aats.org to learn more.
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