Abstract 18378: Comparsion of Cerebral Protection Strategies on Immediate And Longterm Outcome of Patients With Stanford Type a Aortic Dissection

Abstract

Introduction: The optimal protection strategy for use during acute type A aortic dissection surgery is controversial. Hypothesis: To assess the efficacy and immediate and long-term results of different cerebral protection techniques in the treatment of acute type A aortic dissection. Methods: Between April 1987 and January 2015, 400 patients (270 male patients; mean age 58 years; range 15-88) with acute type A dissection underwent surgical aortic repair with an open distal anastomosis. Either hypothermic circulatory arrest alone at 18 °C (n = 111; 28%) or combined with retrograde cerebral perfusion (n = 117; 29%) or antegrade cerebral perfusion at 25 °C (n = 172; 43%) was used for cerebral protection. Results: The median circulatory arrest time was 35 minutes. The overall 30-day mortality was 16% (63 of 400). The 30-day mortality stratified by group was 20% (22 patients) in the hypothermic circulatory arrest group, 17% in the retrograde cerebral perfusion group (20 patients), and 12% (21 patients) in the antegrade cerebral perfusion group (P = .021). Permanent neurologic dysfunction occurred in 53 patients (14%), with statistically significant differences among the 3 groups (25% for hypothermic circulatory arrest, 13% for retrograde cerebral perfusion, and 7% for antegrade cerebral perfusion; P = 0.01). Univariate analysis showed a significant effect of the cerebral protection strategies on 30-day mortality and neurologic outcome. Kaplan-Meier analysis showed differences among the 3 groups with a 1-, 2-, and 5-year survival rate of 85%, 82%, and 77% with antegrade cerebral perfusion, 75%, 72%, and 66% with retrograde cerebral perfusion, and 65%, 64%, and 62% with hypothermic circulatory arrest alone (p=0.19). Conclusion: Antegrade cerebral perfusion group had a superior 30 day as well as midterm survival and inferior rate of PND. During the study period, several significant improvements in surgical as well anaesthesiological in treatment and management of acute type A aortic dissection were achieved. However, postoperative outcome of patients with type A dissection is multifactorial and independent predictors of mortality and permanent neurologic dysfunction were difficult to identify