Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral

Abstract

Background Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. Methods 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). Results For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. Conclusions In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion.

Unilateral versus bilateral anterograde cerebral perfusion in acute type A aortic dissection repair: A systematic review and meta-analysis

“…Detailed study selection process is presented inSupplemental Figure 1 . Ultimately, 8 studies reporting on cumulatively 2416 patients, 843 patients undergoing UACP and 1573 patients undergoing BACP were included in this metaanalysis 6,7,[16][17][18][19][20][21] . Study characteristics are reported in Table 1 .…”

“…ICU stay duration was reported in five studies 7,16,17,19,20 . UACP demonstrated increased ICU stay length compared to BACP (SMD: 0.16, 95%CI: [0.01] -[0.31], p =0.04, I 2 =28.56%).…”

“…6,[16][17][18][19][20][21] and no difference was noted between UACP and BACP groups (SMD: -0.04, 95%CI: [-0.38] -[0.29], p =0.79, I 2 =91.29%). CPB duration was reported in 7 studies6,7,16,17,[19][20][21] .…”

“…6,[16][17][18][19][20][21] and no difference was noted between UACP and BACP groups (SMD: -0.04, 95%CI: [-0.38] -[0.29], p =0.79, I 2 =91.29%). CPB duration was reported in 7 studies6,7,16,17,[19][20][21] . CPB time did not differ significantly between the groups (SMD: 0.11, 95%CI: [-0.22] -[0.44], p =0.52, I 2 =89.65%).…”

“…The two groups were comparable in terms of PND (OR: 0.94, 95%CI: [0.52] -[1.70],p =0.84, I 2 =69.34%). (Figure2.A) TND TND events were reported in seven included studies6,7,16,17,[19][20][21] . Overall, 85 patients presented TND in the UACP group (11.7%, n=85/726) and 76 patients in the BACP group (9.3%, n=76/813).…”