Different Hypothermia In Acute Type A Aortic Dissection: A Systematic Review And Meta-analysis

Objectives:The optimal hypothermia condition under antegrade cerebral perfusion for surgery of Acute type A aortic dissection is still controversial due to the inconsistent or even conflicting results of relative studies.The goal of our meta-analysis was to obtain a synthetic conclusion as a reference for the selection of intraoperative temperature.Methods:All relevant studies were discovered by searching Pubmed,Embase,Cochrane Library,CNKI,Wanfang database and VIP database.15 studies with 1356patients were included in this Meta-analysis.Fixed or random effect model were applied to draw a pooled results,heterogeneity were calculated by Cochrane Q and I~2tests.Sensitivity analysis and detection of publications bias were used to assessed the robustness of results.Results:Under antegrade cerebral perfusion,patients in the Moderate or Mild hypothermia group were associated with a lower early mortality(OR=0.59,95%CI0.40-0.87]and a lower incidence of temporary neurologic dysfunction,permanent neurologic dysfunction(OR=0.44,95%CI 0.31-0.62;OR=0.44,95%CI 0.31-0.64).Besides,Moderate or Mild hypothermia demonstrated superior outcomes on postoperative renal failure and pulmonary infection(OR=0.54,95%CI 0.32-0.90;OR=0.605,95%CI 0.391-0.936).Of note,MH could also shorten the recovery period of patients with ATAAD,such as length of hospital stay(day)and ICU stay(h)(WMD=-0.951,95%CI-1.124--0.750;WMD=-0.38,95%CI-0.58--0.18).Conclusions:Compared with Deep hypothermia,Moderate or Mild hypothermia could significantly reduced the early mortality and incidence of neurologic complications of patients with acute Stanford type A aortic dissection,promoted postoperative recovery of patients.