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(Circulation. 2002;106:I-218.)
© 2002 American Heart Association, Inc.

Aortic and Peripheral Vascular Surgery

Does Profound Hypothermic Circulatory Arrest Improve Survival in Patients With Acute Type A Aortic Dissection?

David T. Lai, FRACS; Robert C. Robbins, MD; R. Scott Mitchell, MD; Kathleen A. Moore, BS; Philip E. Oyer, MD, PhD; Norman E. Shumway, MD, PhD; Bruce A. Reitz, MD; D. Craig Miller, MD

From the Department of Cardiovascular and Thoracic Surgery, Stanford University School of Medicine, Stanford, Calif.

Correspondence to D. Craig Miller, MD, Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, California 94305-5247. E-mail dcm{at}stanford.edu

Objective No evidence exists that profound hypothermic circulatory arrest (PHCA) improves survival or reduces the likelihood of distal aortic reoperation in patients with acute type A aortic dissection.

Methods Records of 307 patients with acute type A aortic dissection from 1967 to 1999 were retrospectively reviewed. The influence of repair using PHCA (n=121) versus without PHCA (n=186) on death and freedom from distal aortic reoperation was analyzed using multivariable Cox regression models. Propensity score analysis identified a subset of 152 comparable patients in 3 quintiles (QIII–V) in which the effects of PHCA (n=113) versus no PHCA (n=39) were further compared.

Results For all patients, 30-day, 1-year, and 5-year survival estimates were 81±2%, 74±3%, and 63±3% (±1 SE). Survival rates and actual freedom from distal aortic reoperation was not significantly different between treatment methods in the entire patient cohort nor in the matched patients in quintiles III–V. Treatment method was not associated with differences in early major complications, late survival, or distal aortic reoperation rates in the entire patient sample or in quintiles III–V.

Conclusions Aortic repair with or without circulatory arrest was associated with comparable early complications, survival, and distal aortic reoperation rates in patients with acute type A aortic dissection. Despite the lack of concrete evidence favoring the use of PHCA, it does no harm, and most of our group uses PHCA regularly because of its practical technical advantages and theoretical potential merit.

Key Words: aortic dissection • ascending thoracic aorta • profound hypothermic circulatory arrest • cardiopulmonary bypass • thoracic aortic aneurysm