Evidence of Global Warming: A Meta-Analysis of Temperature Management in Aortic Arch Surgery
Sprache des Titels:
Objectives: Treatment of aortic pathologies involving the distal ascending aorta, aortic arch, and descending
aorta remains a complex and challenging procedure. Appropriate management is important to achieve satisfactory
outcome. Surgical management aims to reduce the time of circulatory arrest. The optimal level of hypothermia is
still a matter of debate. The present meta-analysis shows the influence of different temperature levels on mortality
and morbidity following aortic arch surgery.
Methods: We performed a meta-analysis of published data between January 2000 and March 2020 based on a
literature research. 120 studies were included with a total of 32,323 patients divided into three different groups of
systemic hypothermia (temperature group 1: ? 25°C, temperature group 2: 25-20°C, temperature group 3: ? 20°C)
were used for statistical analysis.
Results: Early mortality was lowest in temperature group 1 compared to group 2 (OR=1.42; 95% CI, 1.09-1.85;
p=0.01) and group 3 (OR=1.74; 95% CI, 1.20?2.52; p=0.003). Perioperative stroke appeared to be less frequently in
temperature group 1 versus group 2 (OR=1.48; 95% CI, 1.20-1.82; p=0.0002) and group 3 (OR=1.61; 95% CI, 1.19-
2.18; p=0.002). Similar results are obtained concerning new renal insufficiency (group 1 versus group 2: OR=1.20;
95% CI, 0.91-1.57, p=0.19; group 1 versus 3: OR=0.94; 95% CI, 0.67-1.32, p=0.73) and re-exploration for bleeding
(group 1 versus group 2: OR=1.10; 95% CI, 0.80-1.53, p=0.55; group 1 versus group 3: OR=1.92; 95% CI, 1.26-2.94,
Conclusions: We observed that moderate level of hypothermia during circulatory arrest reduced the incidence of
early mortality. Most dreaded neurologic complications occurred less frequently in TG 1. In contrast there was no
difference with regards with new onset of renal failure which is commonly accepted as a reliable marker of the quality
of visceral organ protection.
Keywords: Hypothermia; Hypothermic circulatory arrest; Aortic dissection; Aortic aneurysm