Τίτλος:
Antegrade and Retrograde Cerebral Perfusion During Acute Type A Aortic Dissection Repair in 290 Patients
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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)
Συγγραφείς:
Samanidis, G.
Kanakis, M.
Khoury, M.
Balanika, M.
Antoniou, T.
Giannopoulos, N.
Stavridis, G.
Perreas, K.
Περιοδικό:
Heart, Lung and Circulation
Εκδότης:
Elsevier Ireland Ltd
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.hlc.2020.12.007
