Immediate Clinical Outcome after Prolonged Periods of Brain Protection: Retrospective Comparison of Hypothermic Circulatory Arrest, Retrograde, and Antegrade Perfusion

Apaydin, Anil Z.; Îslamoğlu, Fatih; Aşkar, Fatma Zekiye; Engin, Çağatay; Posacıoğlu, Hakan; Yağdı, Tahir; Ayik, Fatih

doi:10.1111/j.1540-8191.2008.00772.x

Cited by 21 publications

(18 citation statements)

References 15 publications

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“…We amalgamated the TND outcomes of 16 retrospective studies and two prospective studies as total TND (1)(2)(3)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)23,24,36,37), then conducted a subgroup analysis comparing the two types of study. The pooled RR for TND in the retrospective studies was 0.771 (95% CI = [0.614, 0.900]), and the z-score was 2.24 (P = 0.025).…”

Section: Resultsmentioning

confidence: 99%

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Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients

Guo

Sun

et al. 2015

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In aortic arch surgery, deep hypothermic circulatory arrest (DHCA) combined with cerebral perfusion is employed worldwide as a routine practice. Even though antegrade cerebral perfusion (ACP) is more widely used than retrograde cerebral perfusion (RCP), the difference in benefit and risk between ACP and RCP during DHCA is uncertain. The purpose of this meta-analysis is to compare neurologic outcomes and early mortality between ACP and RCP in patients who underwent aortic surgery during DHCA. PubMed, EMBASE, and the Cochrane Library were searched using the key words "antegrade," "retrograde," "cerebral perfusion," "cardiopulmonary bypass," "extracorporeal circulation," and "cardiac surgery" for studies reporting on clinical endpoints including early mortality, stroke, temporary neurologic dysfunction (TND), and permanent neurologic dysfunction (PND) in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was analyzed with the Cochrane Q statistic and I(2) statistic. Publication bias was tested with Begg's funnel plot and Egger's test. Thirty-four studies were included in this meta-analysis, with 4262 patients undergoing DHCA + ACP and 2761 undergoing DHCA + RCP. The overall pooled relative risk for TND was 0.722 (95% CI = [0.579, 0.900]), and the z-score for overall effect was 2.9 (P = 0.004). There was low heterogeneity (I(2) = 18.7%). The analysis showed that patients undergoing DHCA + ACP had better outcomes than those undergoing DHCA + RCP in terms of TND, while there were no significant differences between groups in terms of PND, stroke, and early mortality. This meta-analysis indicates that DHCA + ACP has an advantage over DHCA + RCP in terms of TND, while the two methods show similar results in terms of PND, early mortality, and stroke.

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Section: Resultsmentioning

confidence: 99%

“…4). Ten studies provided data on stroke (4,8,9,11,12,14,26,27,32,34). We used a random-effects model because of high heterogeneity.…”

Section: Resultsmentioning

confidence: 99%

Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients

Guo

Sun

et al. 2015

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“…Modern techniques such as selective antegrade or retrograde cerebral perfusion (ACP or RCP) under moderate hypothermic circulatory arrest (MHCA) have substantially reduced these risks and are now widely used all over the world. 10,11,12,13 Nevertheless, 30-day mortality can still be as high as 5.3-19%; 14,15 stroke incidence, 6.7-10%; 16,17 and acute kidney injury, 19-54%. 18,19 Reducing ischemic injury to the viscera and lower body is key to further improve outcomes in patients undergoing TARS.…”

Section: Introductionmentioning

confidence: 99%

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Lin

Liu

Xiong

et al. 2020

Preprint

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Abstract OBJECTIVESAntegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes.METHODSThis pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products.RESULTSA total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21–1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, p = 0.006; OR: 0.26; 95% CI: 0.10–0.67). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group.CONCLUSIONSRIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications.Trial registrationPilot study of a RCT registered in clinicaltrials.gov (NCT03607786)，Registered 30 July, 2018- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786.

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“…Nevertheless, ACP+MHCA is associated with overall 30-day mortality rates of 5.3-19% [22,23] and stroke rates of 6.7-10%. [24,25] The incidence of acute kidney injury in ACP+MHCA ranges from 19 to 54%, [26,27] with 5-9% of these patients requiring renal replacement therapy, which is itself associated with an elevated short-term mortality rate of 30-75%. [26,28] Since lower-body circulatory arrest is needed during ACP, organs in the lower body such as the viscera and spinal cord are still at risk of ischemia.…”

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confidence: 99%

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery (RIVP-TARS): study protocol for a multicenter, randomized, controlled trial

Lin

Tan

Hao

et al. 2019

Preprint

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Background: During total aortic arch replacement surgery (TARS) for patients with acute type A aortic dissection, organs in the lower body such as the viscera and spinal cord are at risk of ischemia even when antegrade cerebral perfusion (ACP) is performed. Combining ACP with retrograde inferior vena caval perfusion (RIVP) during TARS may improve outcomes by providing the lower body with oxygenated blood. Methods: This study is designed as a multicenter, computer-generated randomized, controlled, assessor-blind, parallel-group study with a superiority framework in patients scheduled for TARS.A total of 636 patients will be randomized on a 1:1 basis to a moderate hypothermia circulatory arrest (MHCA) group, who will receive selective ACP with moderate hypothermia during TARS; or to an RIVP group, who will receive the combination of RIVP and selective ACP under moderate hypothermia during TARS. The primary outcome will be a composite of early mortality and major complications, including paraplegia, postoperative renal failure, severe liver dysfunction and gastrointestinal complications. All patients will be analyzed according to the intention- to-treat protocol. Discussion: This study aims to assess whether RIVP combined with ACP leads to superior outcomes than ACP alone for patients undergoing TARS under moderate hypothermia. This study seeks to provide high-quality evidence for RIVP to be used in patients with acute type A aortic dissection undergoing TARS. Trial registration. Clinicaltrials.gov, NCT03607786. Registered on 30 July 2018.

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Immediate Clinical Outcome after Prolonged Periods of Brain Protection: Retrospective Comparison of Hypothermic Circulatory Arrest, Retrograde, and Antegrade Perfusion

Cited by 21 publications

References 15 publications

Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients

Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

Retrograde inferior vena caval perfusion for total aortic arch replacement surgery (RIVP-TARS): study protocol for a multicenter, randomized, controlled trial

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