A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion.

TLDR

Deep hypothermic circulatory arrest (DHCA) in aortic arch surgery has been linked to coagulopathy, heightened inflammation, and end‑organ dysfunction, prompting interest in moderate hypothermia with selective antegrade cerebral perfusion (MHCA+SACP) to mitigate these risks while preserving neuroprotection. This meta‑analysis compares postoperative outcomes of DHCA versus MHCA+SACP in arch surgery. The authors searched six databases up to January 2013, screened studies independently, extracted data, and meta‑analysed nine comparative trials defined by a hypothermia temperature consensus. MHCA+SACP was associated with a significantly lower stroke rate (P = 0.0007, I² = 0%) and similar rates of temporary neurological deficit, mortality, renal failure, and bleeding, while insufficient data precluded analysis of other systemic outcomes.

Abstract

A recent concern of deep hypothermic circulatory arrest (DHCA) in aortic arch surgery has been its potential association with increased risk of coagulopathy, elevated inflammatory response and end-organ dysfunction. Recently, moderate hypothermic circulatory arrest (MHCA) with selective antegrade circulatory arrest (SACP) seeks to negate potential hypothermia-related morbidities, while maintaining adequate neuroprotection. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA or MHCA+SACP as neuroprotective strategies.Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA with MHCA+SACP, as defined by a recent hypothermia temperature consensus. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.Nine comparative studies were identified for inclusion in the present meta-analysis. Stroke rates were significantly lower in patients undergoing MHCA+SACP (P=0.0007, I(2)=0%), while comparable results were observed with temporary neurological deficit, mortality, renal failure or bleeding. Infrequent and inconsistent reporting of systemic outcomes precluded analysis of other systemic outcomes.The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.