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

David H Tian; Benjamin Wan; Paul G Bannon; Martin Misfeld; Scott A. LeMaire; Teruhisa Kazui; Nicholas T. Kouchoukos; John A. Elefteriades; Joseph E. Bavaria; Joseph S. Coselli; Randall B. Griepp; Friedrich W. Mohr; Aung Oo; Lars G. Svensson; G. Chad Hughes; Tristan D. Yan

doi:10.3978/j.issn.2225-319X.2013.03.13

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

David H Tian, Benjamin Wan, Paul G Bannon, Martin Misfeld, Scott A. LeMaire, Teruhisa Kazui, Nicholas T. Kouchoukos, John A. Elefteriades, Joseph E. Bavaria, Joseph S. Coselli, Randall B. Griepp, Friedrich W. Mohr, Aung Oo, Lars G. Svensson, G. Chad Hughes, Tristan D. Yan

Research output: Contribution to journal › Article › peer-review

Abstract

Introduction: 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.

Methods: 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.

Results: 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.

Conclusions: The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.

Original language	English
Pages (from-to)	148-58
Number of pages	11
Journal	Annals of Cardiothoracic Surgery
Volume	2
Issue number	2
DOIs	https://doi.org/10.3978/j.issn.2225-319X.2013.03.13
Publication status	Published - Mar 2013
Externally published	Yes

Keywords

Deep hypothermic circulatory arrest
moderate hypothermic circulatory arrest
antegrade cerebral perfusion
meta-analysis

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10.3978/j.issn.2225-319X.2013.03.13

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Tian, D. H., Wan, B., Bannon, P. G., Misfeld, M., LeMaire, S. A., Kazui, T., Kouchoukos, N. T., Elefteriades, J. A., Bavaria, J. E., Coselli, J. S., Griepp, R. B., Mohr, F. W., Oo, A., Svensson, L. G., Hughes, G. C., & Yan, T. D. (2013). A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion. Annals of Cardiothoracic Surgery, 2(2), 148-58. https://doi.org/10.3978/j.issn.2225-319X.2013.03.13

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title = "A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion",

abstract = "Introduction: 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.Methods: 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.Results: 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.Conclusions: The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.",

keywords = "Deep hypothermic circulatory arrest, moderate hypothermic circulatory arrest, antegrade cerebral perfusion, meta-analysis",

author = "Tian, {David H} and Benjamin Wan and Bannon, {Paul G} and Martin Misfeld and LeMaire, {Scott A.} and Teruhisa Kazui and Kouchoukos, {Nicholas T.} and Elefteriades, {John A.} and Bavaria, {Joseph E.} and Coselli, {Joseph S.} and Griepp, {Randall B.} and Mohr, {Friedrich W.} and Aung Oo and Svensson, {Lars G.} and Hughes, {G. Chad} and Yan, {Tristan D.}",

year = "2013",

month = mar,

doi = "10.3978/j.issn.2225-319X.2013.03.13",

language = "English",

volume = "2",

pages = "148--58",

journal = "Annals of Cardiothoracic Surgery",

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Tian, DH, Wan, B, Bannon, PG, Misfeld, M, LeMaire, SA, Kazui, T, Kouchoukos, NT, Elefteriades, JA, Bavaria, JE, Coselli, JS, Griepp, RB, Mohr, FW, Oo, A, Svensson, LG, Hughes, GC & Yan, TD 2013, 'A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion', Annals of Cardiothoracic Surgery, vol. 2, no. 2, pp. 148-58. https://doi.org/10.3978/j.issn.2225-319X.2013.03.13

TY - JOUR

T1 - A meta-analysis of deep hypothermic circulatory arrest versus moderate hypothermic circulatory arrest with selective antegrade cerebral perfusion

AU - Tian, David H

AU - Wan, Benjamin

AU - Bannon, Paul G

AU - Misfeld, Martin

AU - LeMaire, Scott A.

AU - Kazui, Teruhisa

AU - Kouchoukos, Nicholas T.

AU - Elefteriades, John A.

AU - Bavaria, Joseph E.

AU - Coselli, Joseph S.

AU - Griepp, Randall B.

AU - Mohr, Friedrich W.

AU - Oo, Aung

AU - Svensson, Lars G.

AU - Hughes, G. Chad

AU - Yan, Tristan D.

PY - 2013/3

Y1 - 2013/3

N2 - Introduction: 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.Methods: 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.Results: 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.Conclusions: The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.

AB - Introduction: 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.Methods: 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.Results: 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.Conclusions: The present meta-analysis indicated the superiority of MHCA+SACP in terms of stroke risk.

KW - Deep hypothermic circulatory arrest

KW - moderate hypothermic circulatory arrest

KW - antegrade cerebral perfusion

KW - meta-analysis

U2 - 10.3978/j.issn.2225-319X.2013.03.13

DO - 10.3978/j.issn.2225-319X.2013.03.13

M3 - Article

C2 - 23977575

SN - 2225-319X

VL - 2

SP - 148

EP - 158

JO - Annals of Cardiothoracic Surgery

JF - Annals of Cardiothoracic Surgery

IS - 2

ER -

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

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Keywords

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