{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T02:35:07Z","timestamp":1788230107494,"version":"build-2803163510"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>The impact of different degrees of hypothermia in patients undergoing type A aortic dissection (TAAD) repair remains controversial. The purpose of this study was to compare the clinical outcomes of patients who received deep hypothermic circulatory arrest (DHCA) (&amp;lt;20\u00b0C) and those of patients who received moderate hypothermic circulatory arrest (MHCA) (20\u201328\u00b0C).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Between January 2011 and December 2020, 143 patients underwent surgical treatment for TAAD with CA and unilateral antegrade selective cerebral perfusion (uSCP). In this retrospective analysis, we evaluated the clinical outcomes of 143 individuals (103 who received DHCA vs. 40 who received MHCA). The primary outcome was the composite of major events (CMEs) including delirium, acute kidney injury (AKI), and in-hospital mortality. The secondary outcomes were overall mortality, bleeding, rethoracotomy, and length of intensive care unit (ICU) stay, among other things.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Compared with the MHCA group, the DHCA group presented a greater incidence of postoperative complications, as follows: AKI (26 (25.2%) vs. 3 (7.5%), <jats:italic>p\u2009<\/jats:italic>=\u20090.020), delirium (23 (22.3%) vs. 2 (5%), <jats:italic>p\u2009<\/jats:italic>=\u20090.014), re-exploration rate (21 (20.4%) vs. 2 (5.0%), <jats:italic>p\u2009<\/jats:italic>=\u20090.024), and prolonged intensive care unit (ICU) stay (7.8 (4.4, 14.1) vs. 5.7 (2.4, 10) days, <jats:italic>p\u2009<\/jats:italic>=\u20090.019). The median cardiopulmonary bypass time (255 (210, 280) vs. 210 (190, 251)\u2005min, <jats:italic>p\u2009<\/jats:italic>=\u20090.010) and median cross-clamp time (140 (110, 180) vs. 125 (100, 160)\u2005min, <jats:italic>p\u2009<\/jats:italic>=\u20090.023) were significantly longer in the DHCA group. The German Registry for Acute Aortic Dissection Type A (GERAADA) score was significantly higher in the MHCA group (22.7\u2009\u00b1\u20099.1 vs. 19\u2009\u00b1\u20097.2, <jats:italic>p\u2009<\/jats:italic>=\u20090.012). The adjusted odds ratio for CME in the MHCA group was 0.78 (95% CI: 0.52\u20131.17, <jats:italic>p\u2009<\/jats:italic>=\u20090.001). The use of MHCA demonstrated a protective effect on reducing postoperative delirium (OR: 0.28, 95% CI: 0.14\u20130.46, <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.01) and postoperative AKI (OR: 0.29, 95% CI: 0.14\u20130.49, <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.01). Overall survival after two years did not differ between the two groups (log-rank, <jats:italic>p\u2009<\/jats:italic>=\u20090.16).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The principal findings of our study indicate that DHCA elevates the risk of postoperative AKI and delirium. As a result, the duration of hospitalization and intensive care unit stay was markedly extended. Consequently, MHCA should be favored over DHCA when the clinical circumstances permit, since DHCA remains a secure alternative in intricate dissection instances.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2024.1447007","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T04:27:33Z","timestamp":1727411253000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":15,"title":["Temperature management in acute type A aortic dissection treatment: deep vs. moderate hypothermic circulatory arrest. Is colder better?"],"prefix":"10.3389","volume":"11","author":[{"given":"Hend Abdulwahab Muftah","family":"Abdulwahab","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alish","family":"Kolashov","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Assad","family":"Haneya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Klump","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay","family":"Moza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad Fateh","family":"Arab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Shoaib","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rashad","family":"Zayat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Amen","family":"Khattab","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1009","DOI":"10.1001\/jamacardio.2022.2718","article-title":"Early mortality in type a acute aortic dissection: insights from the international registry of acute aortic dissection","volume":"7","author":"Harris","year":"2022","journal-title":"JAMA Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 Esc guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (esc)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"33","DOI":"10.12945\/j.aorta.2017.16.034","article-title":"Cause of death following surgery for acute type a dissection: evidence from the Canadian thoracic aortic collaborative","volume":"5","author":"McClure","year":"2017","journal-title":"Aorta (Stamford"},{"key":"B4","doi-asserted-by":"publisher","first-page":"e44","DOI":"10.1093\/ejcts\/ezv356","article-title":"Mortality in patients with acute aortic dissection type A: analysis of Pre- and intraoperative risk factors from the German registry for acute aortic dissection type a (GERAADA)","volume":"49","author":"Conzelmann","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"B5","doi-asserted-by":"publisher","first-page":"5582","DOI":"10.21037\/jtd-20-2213","article-title":"Operative mortality in adult cardiac surgery: is the currently utilized definition justified?","volume":"13","author":"Chan","year":"2021","journal-title":"J Thorac Dis"},{"key":"B6","doi-asserted-by":"publisher","first-page":"163","DOI":"10.3978\/j.issn.2225-319X.2013.03.03","article-title":"Consensus on hypothermia in aortic arch surgery","volume":"2","author":"Yan","year":"2013","journal-title":"Ann Cardiothorac Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1016\/s0003-4975(00)01592-7","article-title":"Deep hypothermic circulatory arrest: I. Effects of cooling on electroencephalogram and evoked potentials","volume":"71","author":"Stecker","year":"2001","journal-title":"Ann Thorac Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1895","DOI":"10.1016\/s0003-4975(99)00441-5","article-title":"Cerebral metabolic suppression during hypothermic circulatory arrest in humans","volume":"67","author":"McCullough","year":"1999","journal-title":"Ann Thorac Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"274","DOI":"10.23736\/s0021-9509.17.09864-0","article-title":"Cardiopulmonary bypass time: every minute counts","volume":"59","author":"Madhavan","year":"2018","journal-title":"J Cardiovasc Surg (Torino)"},{"key":"B10","doi-asserted-by":"publisher","first-page":"13","DOI":"10.36518\/2689-0216.1525","article-title":"Complications of cardiopulmonary bypass from an anesthesia perspective: a clinical review","volume":"4","author":"Roberts","year":"2023","journal-title":"HCA Healthc J Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"622","DOI":"10.1186\/s12872-023-03664-3","article-title":"Association between cardiopulmonary bypass time and mortality among patients with acute respiratory distress syndrome after cardiac surgery","volume":"23","author":"Hu","year":"2023","journal-title":"BMC Cardiovasc Disord"},{"key":"B12","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"65","author":"Czerny","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1109","DOI":"10.1093\/ejcts\/ezaa455","article-title":"Evaluation of the GERAADA score for prediction of 30-day mortality in patients with acute type a aortic dissection","volume":"59","author":"Luehr","year":"2021","journal-title":"Eur J Cardiothorac Surg"},{"key":"B14","volume-title":"Stata Causal Inference and Treatment-Effects Estimation Reference Manual Release 18","year":"2023"},{"key":"B15","doi-asserted-by":"publisher","first-page":"906","DOI":"10.1016\/j.ejcts.2005.01.057","article-title":"Long and short-term outcomes in patients requiring continuous renal replacement therapy post cardiopulmonary bypass","volume":"27","author":"Luckraz","year":"2005","journal-title":"Eur J Cardiothorac Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1016\/j.jtcvs.2013.03.004","article-title":"Moderate hypothermia during aortic arch surgery is associated with reduced risk of early mortality","volume":"146","author":"Tsai","year":"2013","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B17","doi-asserted-by":"publisher","first-page":"2210","DOI":"10.1053\/j.jvca.2018.02.026","article-title":"Acute kidney injury after total arch replacement combined with frozen elephant trunk implantation: incidence, risk factors, and outcome","volume":"32","author":"Zhou","year":"2018","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B18","doi-asserted-by":"publisher","first-page":"668333.","DOI":"10.3389\/fcvm.2021.668333","article-title":"Optimal degree of hypothermia in total arch replacement for type a aortic dissection","volume":"8","author":"Wu","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e017939","DOI":"10.1161\/jaha.120.017939","article-title":"Effect of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest in aortic arch surgery on postoperative renal function: a systematic review and meta-analysis","volume":"9","author":"Cao","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"B20","doi-asserted-by":"publisher","first-page":"110075","DOI":"10.1016\/j.isci.2024.110075","article-title":"Bradykinin induces acute kidney injury after hypothermic circulatory arrest through the repression of the Nrf2-Xct pathway","volume":"27","author":"Li","year":"2024","journal-title":"iScience"},{"key":"B21","doi-asserted-by":"publisher","first-page":"2378","DOI":"10.1111\/jocs.16614","article-title":"The long-term impact of acute renal failure after aortic arch replacement for acute type a aortic dissection","volume":"37","author":"Brown","year":"2022","journal-title":"J Card Surg"},{"key":"B22","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1053\/j.jvca.2005.05.004","article-title":"Major clinical outcomes in adults undergoing thoracic aortic surgery requiring deep hypothermic circulatory arrest: quantification of organ-based perioperative outcome and detection of opportunities for perioperative intervention","volume":"19","author":"Augoustides","year":"2005","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"B23","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1055\/s-0028-1086129","article-title":"Alterations of hemostasis associated with cardiopulmonary bypass: pathophysiology, prevention, diagnosis, and management","volume":"3","author":"Bick","year":"1976","journal-title":"Semin Thromb Hemost."},{"key":"B24","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1111\/jth.15195","article-title":"Managing the coagulopathy associated with cardiopulmonary bypass","volume":"19","author":"Bartoszko","year":"2021","journal-title":"J Thromb Haemost"},{"key":"B25","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1093\/ejcts\/ezac208","article-title":"Long-term outcome of patients undergoing re-exploration for bleeding following cardiac surgery: a swedeheart study","volume":"62","author":"Heimisdottir","year":"2022","journal-title":"Eur J Cardiothorac Surg"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1563","DOI":"10.1016\/j.athoracsur.2015.05.032","article-title":"Moderate versus deep hypothermia with unilateral selective antegrade cerebral perfusion for acute type a dissection","volume":"100","author":"Leshnower","year":"2015","journal-title":"Ann Thorac Surg"},{"key":"B27","doi-asserted-by":"publisher","first-page":"46","DOI":"10.1186\/s13019-024-02548-7","article-title":"Risk factors for prolonged postoperative ICU stay in the patients with Stanford type a aortic dissection","volume":"19","author":"Liu","year":"2024","journal-title":"J Cardiothorac Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1016\/j.jtcvs.2019.02.045","article-title":"Cerebral protection strategies in aortic arch surgery: a network meta-analysis","volume":"159","author":"Hameed","year":"2020","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/j.neuroscience.2011.12.034","article-title":"Hypothermia and rewarming injury in hippocampal neurons involve intracellular Ca2+and glutamate excitotoxicity","volume":"207","author":"Warren","year":"2012","journal-title":"Neuroscience"},{"key":"B30","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1016\/j.ejcts.2006.05.031","article-title":"Hypothermic circulatory arrest with moderate, deep or profound hypothermic selective antegrade cerebral perfusion: which temperature provides best brain protection?","volume":"30","author":"Khaladj","year":"2006","journal-title":"Eur J Cardiothorac Surg"},{"key":"B31","doi-asserted-by":"publisher","first-page":"1129","DOI":"10.1007\/s12630-017-0938-5","article-title":"Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass","volume":"64","author":"O'Neal","year":"2017","journal-title":"Can J Anaesth"},{"key":"B32","doi-asserted-by":"publisher","first-page":"359","DOI":"10.2147\/cia.S350195","article-title":"Prediction of postoperative delirium after cardiac surgery with a quick test of cognitive speed, mini-mental state examination and hospital anxiety and depression scale","volume":"17","author":"Segern\u00e4s","year":"2022","journal-title":"Clin Interv Aging"},{"key":"B33","doi-asserted-by":"publisher","first-page":"OP159","DOI":"10.1055\/s-0032-1332398","article-title":"Risk factors and incidence for postop delirium in patients undergoing cardiac surgery with cardiopulmonary bypass support vs. off pump surgery","volume":"61","author":"Dzemali","year":"2013","journal-title":"Thorac Cardiovasc Surg"},{"key":"B34","doi-asserted-by":"publisher","first-page":"372","DOI":"10.1016\/j.jcrc.2006.09.001","article-title":"Risk factors for the development of early-onset delirium and the subsequent clinical outcome in mechanically ventilated patients","volume":"23","author":"Lin","year":"2008","journal-title":"J Crit Care"},{"key":"B35","doi-asserted-by":"publisher","first-page":"658","DOI":"10.1161\/circulationaha.123.067022","article-title":"Cognitive effects of body temperature during hypothermic circulatory arrest trial (got ice): a randomized clinical trial comparing outcomes after aortic arch surgery","volume":"149","author":"Hughes","year":"2024","journal-title":"Circulation"},{"key":"B36","doi-asserted-by":"publisher","first-page":"696","DOI":"10.1016\/s0003-4975(99)01524-6","article-title":"Hypothermic circulatory arrest causes multisystem vascular endothelial dysfunction and apoptosis","volume":"69","author":"Cooper","year":"2000","journal-title":"Ann Thorac Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1447007\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T04:27:37Z","timestamp":1727411257000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2024.1447007\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,27]]},"references-count":36,"alternative-id":["10.3389\/fcvm.2024.1447007"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2024.1447007","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,27]]},"article-number":"1447007"}}