Abstract
BackgroundAntegrade 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.Methods321 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).ResultsFor 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.ConclusionsIn 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.
Highlights
Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery
Study populations We retroactively studied 356 patients with type A Aortic dissection (AD) who were admitted to our cardiac surgical intensive care unit after total aortic arch replacement from January 1, 2014 to December 31, 2018. 321 patients undergoing total arch replacement with one of the following manifestations shown on computed tomography angiography (CTA): arch tear, carotid dissection or occlusion, or the presence of an aortic arch aneurysm were included into our research, of whom 124 underwent a unilateral ACP (u-ACP) (38.6%) and 197 underwent a bilateral ACP (b-ACP) (61.4%)
For the u-ACP group, permanent neurologic dysfunction (PND) was observed in 22 patients (17.7%): paraplegia (n = 2), monoplegia (n = 4), hemiplegia (n = 11), and coma (n = 5)
Summary
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. Aortic dissection (AD) is one of the most serious cardiac emergencies owing to associated high mortality rates, especially Stanford type A [1, 2]. The frozen elephant trunk technique is increasingly being used to repair dissections extending over the entire aortic arch. Despite immense improvements in surgical techniques, the. Liu et al BMC Surg (2020) 20:286 operative mortality and complications of type A aortic dissection (AD) remain considerably high [3]. Neurological dysfunction (ND) is a common complication, with a reported case rate ranging from 5.5 to 33.3% [4]. It is crucial to implement appropriate measures to prevent cerebral injury
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