Hypothermic Circulatory Arrest and Early Outcomes in Open Distal Aortic Repair

Abstract The optimal perfusion strategy for open repair of descending and thoracoabdominal aortic pathologies remains controversial. Although hypothermic circulatory arrest (HCA) is established in arch surgery, concerns about neurologic and systemic complications limit its use. This study aimed to evaluate whether HCA adversely affects early outcomes in distal aortic repair. A retrospective analysis was conducted on 90 patients who underwent open repair of descending and thoracoabdominal aortic pathologies between January 2005 and June 2024. Patients were grouped by perfusion strategy as HCA (n = 35) or non-HCA (n = 55). Preoperative, intraoperative, and postoperative variables were compared for 30-day mortality and major postoperative morbidity, including neurological, cardiac, renal, respiratory, and infectious complications. Incremental mortality risk factors were assessed using univariate analysis only. Thirty-day mortality did not differ significantly between the HCA and non-HCA groups (11.4% vs. 7.3%, p = 0.387). Transient cerebral neurologic dysfunction was more frequent in the HCA group (11.4% vs. 0%, p = 0.003), whereas permanent neurologic injury was infrequent. Renal, respiratory, infectious, and cardiac complications were not statistically different between groups. Intensive care unit (ICU) and hospital stay were similar, while postoperative packed red blood cell (PRBC) transfusion requirements were higher in the HCA group (p = 0.016). In univariate analysis, early mortality was associated with urgent/emergent surgery, postoperative cardiac complications, and higher PRBC transfusion requirements. In this single-center, retrospective experience, HCA was used mainly in anatomically challenging distal aortic repairs requiring proximal control. Although the study does not establish equivalence or superiority between perfusion strategies, HCA remains an important surgical adjunct when safe proximal clamping or distal perfusion is not feasible.