TY - JOUR
TI - Antegrade and Retrograde Cerebral Perfusion During Acute Type A Aortic Dissection Repair in 290 Patients
AU - Samanidis, G.
AU - Kanakis, M.
AU - Khoury, M.
AU - Balanika, M.
AU - Antoniou, T.
AU - Giannopoulos, N.
AU - Stavridis, G.
AU - Perreas, K.
JO - Heart, Lung and Circulation
PY - 2021
VL - 30
TODO - 7
SP - 1075-1083
PB - Elsevier Ireland Ltd
SN - 1443-9506, 1444-2892
TODO - 10.1016/j.hlc.2020.12.007
TODO - amino terminal pro brain natriuretic peptide, acute type A aortic dissection;  adult;  antegrade cerebral perfusion;  aortic dissection;  aortic reconstruction;  Article;  brain perfusion;  brain protection;  clinical effectiveness;  controlled study;  female;  follow up;  heart arrest;  human;  length of stay;  major clinical study;  male;  middle aged;  mortality rate;  neurological complication;  outcome assessment;  retrograde cerebral perfusion;  survival rate;  survival time;  brain circulation;  deep hypothermic circulatory arrest;  dissecting aneurysm;  perfusion;  postoperative complication;  retrospective study;  thoracic aorta;  treatment outcome, Aneurysm, Dissecting;  Aorta, Thoracic;  Cerebrovascular Circulation;  Circulatory Arrest, Deep Hypothermia Induced;  Humans;  Perfusion;  Postoperative Complications;  Retrospective Studies;  Treatment Outcome
TODO - Aim: Hypothermia and selective brain perfusion is used for brain protection during an acute type A aortic dissection (ATAAD) correction. We compared the outcomes between antegrade and retrograde cerebral perfusion techniques after ATAAD surgery. Method: Between January 1995 and August 2017, 290 patients underwent ATAAD repair under deep hypothermic circulatory arrest/retrograde cerebral perfusion (DHCA/RCP) in 173 patients and moderate hypothermic circulatory arrest/antegrade cerebral perfusion (MHCA/ACP) in 117 patients. Outcomes of interest were: 30-day mortality, new-onset postoperative neurological complications, and length of intensive care unit (ICU) and in-hospital stays. Results: No differences were observed between the preoperative details of both groups (p>0.05). Thirty-day (30-day) mortality did not differ between groups (RCP vs ACP, 22% vs 21.4%; p=0.90). New-onset postoperative permanent neurological dysfunctions and coma was similar in two group in 6.9% versus 10.3% of patients and 3.8% versus 6.8% patients of patients, respectively (p=0.69). The incidence of 30-day mortality and new postoperative neurological complications were similar in the RCP and ACP groups (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.39–2.83 [p=0.91] and OR, 1.7; 95% CI, 0.87–3.23 [p=0.11], respectively). There was no difference between length of stay in the ICU and overall stay in hospital between the RCP and ACP groups (p=0.31 and p=0.14, respectively). No difference in survival rate was observed between the RCP and ACP groups (hazard ratio, 1.2; 95% CI, 0.76–2.01 [p=0.39]). Conclusions: Thirty-day (30-day) mortality rate, new-onset postoperative neurological dysfunctions, ICU stay, and in-hospital stay did not differ between the MHCA/ACP and DHCA/RCP groups after ATAAD correction. Although the rates of 30-day mortality and postoperative neurological complications were high after ATAAD repair, ACP had no advantages over the RCP technique. © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ)
ER -