Therapeutic effect of mild hypothermia on the inflammatory response and outcome in perioperative patients with acute Stanford type A aortic dissection: A randomized controlled trial_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZOU Lei ¹ ,  ZHANG Cui ¹ , SONG Xiaochun ¹ , FU Run ¹ , SHEN Xiao ¹ , HONG Liang ¹ , MU Xinwei ¹ , HUANG Fuhua ² , XIAO Liqiong ²

1. Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P. R. China;
2. Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, P. R. China;

Corresponding author：

ZHANG Cui, Email: 18951670283@163.com

Keywords：

Acute Stanford type A aortic dissection; mild hypothermia therapy; inflammatory response; organ function

DOI：

10.7507/1007-4848.201805070

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Objective To explore the therapeutic effect of mild hypothermia on the inflammatory response, organ function and outcome in perioperative patients with acute Stanford type A aortic dissection (AAAD). Methods From February 2017 to February 2018, 56 patients with AAAD admitted in our department were enrolled and randomly allocated into two groups including a control group and an experimental group. After deep hypothermia circulatory arrest during operation, in the control group (n=28), the patients were rewarmed to normal body temperatures (36 to 37 centigrade degree), and which would be maintained for 24 hours after operation. While in the experimental group (n=28), the patients were rewarmed to mild hypothermia (34 to 35 centigrade degree), and the rest steps were the same to the control group. The thoracic drainage volume and the incidence of shivering at the first 24 hours after operation, inflammatory indicators and organ function during perioperation, and outcomes were compared between the two groups. There were 20 males and 8 females at age of 51.5±8.7 years in the control group, 24 males and 4 females at age of 53.3±11.2 years in the experimental group.Results There was no obvious difference in the basic information and operation information in patients between the two groups. Compared to the control group, at the 24th hour after operation, the level of peripheral blood matrix metalloproteinases (MMPs) was lower than that in the experimental group (P=0.008). In the experimental group, after operation, the awakening time was much shorter (P=0.008), the incidence of bloodstream infection was much lower (P=0.019). While the incidence of delirium, acute kidney injury (AKI), hepatic insufficiency, mechanical ventilation duration, intensive care unit (ICU) stays, or hospital mortality rate showed no statistical difference. And at the first 24 hours after operation, there was no difference in the thoracic drainage volume between the two groups, and no patient suffered from shivering. Conclusion The mild hypothermia therapy is able to shorten the awakening time and reduce the incidence of bloodstream infection after operation in the patients with AAAD, and does not cause the increase of thoracic drainage volume or shivering.

Citation： ZOU Lei, ZHANG Cui, SONG Xiaochun, FU Run, SHEN Xiao, HONG Liang, MU Xinwei, HUANG Fuhua, XIAO Liqiong. Therapeutic effect of mild hypothermia on the inflammatory response and outcome in perioperative patients with acute Stanford type A aortic dissection: A randomized controlled trial. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(3): 222-228. doi: 10.7507/1007-4848.201805070 Copy

1.	Li Y, Yang N, Duan W, et al. Acute aortic dissection in China. Am J Cardiol, 2012, 110(7): 1056-1061.
2.	易定华, 段维勋. 中国主动脉夹层诊疗现状与展望. 中国循环杂志, 2013, 28(1): 1-2.
3.	肖煜, 陈宣辰, 周建, 等. 主动脉夹层凝血及纤溶系统的功能改变及其意义. 中华普通外科杂志, 2013, 28(4): 322-324.
4.	Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8(1): 31-35.
5.	Del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
6.	Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009, 361(14): 1349-1358.
7.	Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
8.	Mussa FF, Horton JD, Moridzadeh R, et al. Acute aortic dissection and intramural hematoma: a systematic review. JAMA, 2016, 316(7): 754-763.
9.	Didangelos A, Yin X, Mandal K, et al. Extracellular matrix composition and remodeling in human abdominal aortic aneurysms: a proteomics approach. Mol Cell Proteomics, 2011, 10(8): M111.008128.
10.	He R, Guo DC, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg, 2006, 131(3): 671-678.
11.	Tang N, Sun B, Gupta A, et al. Monocyte exosomes induce adhesion molecules and cytokines via activation of NF-κB in endothelial cells. FASEB J, 2016, 30(9): 3097-3106.
12.	Ju X, Ijaz T, Sun H, et al. Interleukin-6-signal transducer and activator of transcription-3 signaling mediates aortic dissections induced by angiotensin Ⅱ via the T-helper lymphocyte 17-interleukin 17 axis in C57BL/6 mice. Arterioscler Thromb Vasc Biol, 2013, 33(7): 1612-1621.
13.	Rumin H, Guo DG, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg, 2006, 131: 671-678.
14.	Wen D, Zhou XL, Li JJ, et al. Plasma concentrations of interleukin-6, C-reactive protein, tumor necrosis factor-α and matrix metalloproteinase-9 in aortic dissection. Clin Chim Acta, 2012, 413: 198-202.
15.	Zhang X, Shen YH, LeMaire SA. Thoracic aortic dissection: are matrix metalloproteinases involved? Vascular, 2009, 17(3): 147-157.
16.	Cifani N, Proietta M, Tritapepe L, et al. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review. Ann Med, 2015, 47(6): 441-446.
17.	Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med, 2015, 372(17): 1629-1638.
18.	Eddy VA, Morris JA Jr, Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am, 2000, 80(3): 845-854.
19.	Staikou C, Paraskeval A, Donta I, et al. The effects of mild hypothermia on coagulation tests and haemodynamic variables in anaesthetized rabbits. West Indian Med J, 2011, 60(5): 513-518.

1. Li Y, Yang N, Duan W, et al. Acute aortic dissection in China. Am J Cardiol, 2012, 110(7): 1056-1061.
2. 易定华, 段维勋. 中国主动脉夹层诊疗现状与展望. 中国循环杂志, 2013, 28(1): 1-2.
3. 肖煜, 陈宣辰, 周建, 等. 主动脉夹层凝血及纤溶系统的功能改变及其意义. 中华普通外科杂志, 2013, 28(4): 322-324.
4. Luo F, Zhou XL, Li JJ, et al. Inflammatory response is associated with aortic dissection. Ageing Res Rev, 2009, 8(1): 31-35.
5. Del Porto F, Proietta M, Tritapepe L, et al. Inflammation and immune response in acute aortic dissection. Ann Med, 2010, 42(8): 622-629.
6. Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy. N Engl J Med, 2009, 361(14): 1349-1358.
7. Nienaber CA, Clough RE. Management of acute aortic dissection. Lancet, 2015, 385(9970): 800-811.
8. Mussa FF, Horton JD, Moridzadeh R, et al. Acute aortic dissection and intramural hematoma: a systematic review. JAMA, 2016, 316(7): 754-763.
9. Didangelos A, Yin X, Mandal K, et al. Extracellular matrix composition and remodeling in human abdominal aortic aneurysms: a proteomics approach. Mol Cell Proteomics, 2011, 10(8): M111.008128.
10. He R, Guo DC, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg, 2006, 131(3): 671-678.
11. Tang N, Sun B, Gupta A, et al. Monocyte exosomes induce adhesion molecules and cytokines via activation of NF-κB in endothelial cells. FASEB J, 2016, 30(9): 3097-3106.
12. Ju X, Ijaz T, Sun H, et al. Interleukin-6-signal transducer and activator of transcription-3 signaling mediates aortic dissections induced by angiotensin Ⅱ via the T-helper lymphocyte 17-interleukin 17 axis in C57BL/6 mice. Arterioscler Thromb Vasc Biol, 2013, 33(7): 1612-1621.
13. Rumin H, Guo DG, Estrera AL, et al. Characterization of the inflammatory and apoptotic cells in the aortas of patients with ascending thoracic aortic aneurysms and dissections. J Thorac Cardiovasc Surg, 2006, 131: 671-678.
14. Wen D, Zhou XL, Li JJ, et al. Plasma concentrations of interleukin-6, C-reactive protein, tumor necrosis factor-α and matrix metalloproteinase-9 in aortic dissection. Clin Chim Acta, 2012, 413: 198-202.
15. Zhang X, Shen YH, LeMaire SA. Thoracic aortic dissection: are matrix metalloproteinases involved? Vascular, 2009, 17(3): 147-157.
16. Cifani N, Proietta M, Tritapepe L, et al. Stanford-A acute aortic dissection, inflammation, and metalloproteinases: a review. Ann Med, 2015, 47(6): 441-446.
17. Kaukonen KM, Bailey M, Pilcher D, et al. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med, 2015, 372(17): 1629-1638.
18. Eddy VA, Morris JA Jr, Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am, 2000, 80(3): 845-854.
19. Staikou C, Paraskeval A, Donta I, et al. The effects of mild hypothermia on coagulation tests and haemodynamic variables in anaesthetized rabbits. West Indian Med J, 2011, 60(5): 513-518.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Therapeutic effect of mild hypothermia on the inflammatory response and outcome in perioperative patients with acute Stanford type A aortic dissection: A randomized controlled trial

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