Evidence of Global Warming: A Meta-analysis of Temperature Management in Aortic Arch Surgery

Objectives: Treatment of aortic pathologies involving the distal ascending aorta, aortic arch and descending aorta remains a complex and challenging procedure. Appropriate management is important to achieve satisfactory outcome. Surgical management requires a time period of circulatory arrest. The optimal hypothermic level is still a matter of debate. The present meta-analysis shows the influence of different temperature levels on mortality and morbidity.

Methods: We performed a meta-analysis of all published data between January 2000 and March 2020 based on a literature research. 120 studies were included. A total of 32 323 patients divided into three different groups of a hypothermic temperature level (temperature group 1: 32–25°C, temperature group 2: 25–20°C, temperature group 3: <20°C) were used for statistical analysis.

Result: Thirty-day mortality rate was lowest in temperature group 1 compared with the others (OR: 1.42; 95% CI: 1.09–1.85). Perioperative stroke was shown to appear less in temperature group 1 (OR: 1.48; 95% CI: 1.20–1.82). Similar findings are concerning new renal insufficiency (OR: 1.20; 95% CI: 0.91–1.57) and bleeding complications (OR: 1.10; 95% CI: 0.80–1.53).

Conclusion: This analysis shows that a moderate hypothermic level reduces the incidence of mortality. Most dreaded neurologic complications happens less in combination with antegrade cerebral perfusion. A fewer new onset of renal failure and lesser bleeding complications underline a warmer temperature level. It is clearly shown that there is no need for colder temperature levels with either total circulatory arrest or in combination with retrograde cerebral perfusion as recent studies from the US advocated.

Publication History

Article published online:
19 February 2021