Is there a need for adjunct cerebral protection in conjunction with deep hypothermic circulatory arrest during noncomplex hemiarch surgery?

Objective Different cerebral protection strategies are currently being practiced during noncomplex hemiarch surgery without randomized control studies to show their relative efficacy. We hypothesized that deep hypothermic circulatory arrest (DHCA) alone was adequate for cerebral protection in noncomplex hemiarch surgery.

Results Preoperative characteristics were similar between groups (12.3% in the DHCA group, 12.3% in the ACP group, and 10.3% in RCP group were reoperations). Patients in the DHCA group had shorter cardiopulmonary bypass times (193 minutes vs 217 minutes; P ≤.005) and total lower body ischemic times (21 minutes vs 30 minutes; P ≤.001) than ACP, but not RCP. Rates of reoperations for bleeding, postoperative stroke, and new renal failure did not differ between groups. New onset of cerebrovascular events were seen in 5.4% of patients in the DHCA group versus 6.2% of patients in the ACP group and 6.4% of patients in the RCP group (all P values >.7). Operative mortality in the DHCA group was 4.7% versus 2.6% in the ACP group and 2.6% in the RCP group (all P values >.4). Cox proportional hazard modeling showed no survival differences between groups.

Conclusions Outcomes and survival using DHCA alone were comparable to adjunct cerebral protection methods in patients undergoing noncomplex hemiarch surgery. DHCA alone is as safe as other adjunct complex cerebral protection techniques and simplifies operation without additional risk.