The Circulatory Arrest Time in Patients with Acute Type A Aortic Dissection: Does It Influence the Outcome?

Objectives: Despite all improvements in perioperative and surgical management, treatment of acute aortic dissection type A (AADA) remains challenging. The surgical options improved with techniques like hypothermic circulatory arrest (HCA) and antegrade selective cerebral perfusion (ACP). The optimal length of circulatory arrest time is still uncertain. This large analysis focused on the impact of HCA length on outcome in patients with AADA.

Methods: Between January 2001 and December 2016, a total of 360 consecutive patients underwent surgery of AADA using HCA and ACP. The patients were divided into two groups: (group A) those with HCA time of 60 min and more (n = 68; 14.2%) and those (group B) with HCA time below 60 min (n = 309; 85.8%).

Results: Patients with long HCA time (group A) were significantly younger (57.8 ± 12.0 vs. 63.8 ± 12.2 years; p = 0.001) and with lower preoperative risk factors (log Euroscore [18.7%; 9.7; 31.0] vs. 24.64% [12.2; 41.3]; p = 0.024). There was no difference between both groups concerning the further clinical presentation. Intraoperatively, complex procedures with aortic arch surgery were more common in patients with long HCA time (group A: 58.8% vs. group B 5.8%; p < 0.001). Accordingly, cardiopulmonary bypass (245 min [208; 304] vs. 156 min [132; 194]; p < 0.001), cross-clamping (139 min [116; 209] vs. 82 min [66; 109]; p < 0.001), and HCA times (87 min [71; 115] vs. 30 min [25; 138]; p < 0.001) were significantly longer in group A. Postoperative rate of permanent or transient neurological deficits were comparable (19.6 vs. 14.9%; p = 394). Only the duration of mechanical ventilation and the rate of tracheotomy were significantly higher in patients with long HCA time (45.1 vs. 19.7%; p < 0.001). No significant differences were noted between the two groups regarding the remaining postoperative data. The 30-day mortality was satisfactory for both groups (15.7 vs. 16.6%; p = 0.876).

Conclusion: Complex surgery in the acute setting of AADA using hypothermic circulatory arrest and selective ACP may be safely applied even for more than 60 minutes with satisfactory results.