Faculty Opinions recommendation of Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair.

Objectives Surgery for acute type A aortic dissection (AAD) remains a surgical challenge with considerable risk of morbidity and mortality. Antegrade cerebral perfusion (ACP) has been popularized, offering a more physiologic method of brain perfusion during complex aortic arch repair, often necessary in setting of AAD. The safe limits of this approach under moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) are yet to be defined. Thus, the current study investigates our clinical results after surgical treatment for AAD in patients with a selective ACP and systemic circulatory arrest time of ≥ 60 minutes in moderate-to-mild hypothermia (≥ 28°C). Methods Between January 2000 and April 2016, 63 consecutive patients underwent surgical treatment for AAD employing selective ACP during moderate-to-mild systemic hypothermia (≥ 28°C) with prolonged ACP and circulatory arrest times. Patients' mean age was 59 ± 15 years, and 39 patients (62%) were men. Hemiarch replacement and total arch replacement were performed in 13 (21%) and 50 (79%) patients, respectively. Frozen elephant trunk, arch light, and elephant trunk technique were performed in nine (14%), six (10%), and three patients (5%), respectively. Clinical data were prospectively entered into our institutional database. Mean late follow-up was 6 ± 4 years and was 98% complete. Results Cardiopulmonary bypass time accounted for 245 ± 81 minutes and the myocardial ischemic time accounted for 140 ± 43 minutes. Mean duration of ACP was 74 ± 12 minutes. The mean lowest core temperature accounted for 28.9 ± 0.8°C. Unilateral ACP was performed in 44 patients (70%); bilateral ACP was used in the remaining 19 patients (30%). Intensive care unit stay reached 6 ± 5 days. New onset of acute renal failure requiring hemofiltration was observed in 8% of patients (n = 5). New postoperative permanent neurologic deficits were found in five patients (8%) and transient neurologic deficits in six patients (10%). There was one case of paraplegia. Thirty-day mortality and in-hospital mortality were 8 (n = 5) and 11% (n = 7), respectively. Overall survival at 5 years was 76 ± 9%. Conclusion Our preliminary data suggest that selective ACP during moderate-to-mild systemic hypothermic circulatory arrest (≥ 28°C) can safely be applied for more than 1 hour even in the setting of AAD.

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Predictors of Outcomes after Correction of Acute Type A Aortic Dissection under Moderate Hypothermic Circulatory Arrest and Antegrade Cerebral Perfusion

Brazilian Journal of Cardiovascular Surgery ◽

10.21470/1678-9741-2017-0123 ◽

2018 ◽

Vol 33 (2) ◽

Author(s):

George Samanidis ◽

Charalampos Katselis ◽

Constantinos Contrafouris ◽

Georgios Georgiopoulos ◽

Ioannis Kriaras ◽

...

Keyword(s):

Aortic Dissection ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Type A ◽

Hypothermic Circulatory Arrest ◽

Acute Type ◽

Type A Aortic Dissection ◽

Predictors Of Outcomes ◽

Antegrade Cerebral Perfusion

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Selective antegrade cerebral perfusion improves neurological outcome in patients with acute type a aortic dissection

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2004-816731 ◽

2004 ◽

Vol 52 (S 1) ◽

Author(s):

C Hagl ◽

N Khaladj ◽

R Leyh ◽

A Schulze ◽

K M�ller-Stahl ◽

...

Keyword(s):

Aortic Dissection ◽

Neurological Outcome ◽

Cerebral Perfusion ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Selective Antegrade Cerebral Perfusion ◽

Antegrade Cerebral Perfusion

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Effect of different types of cerebral perfusion for acute type A aortic dissection, unilateral versus bilateral

10.21203/rs.3.rs-22196/v2 ◽

2020 ◽

Author(s):

zhengqin liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

changcun fang ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Incidence ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction ◽

Ventilation Time

Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used way for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research was aimed to investigate the clinical effects between u-ACP and b-ACP. Methods: 321 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. We also analyzed perioperative variables in order to find the potential associated factors for neurolocial dysfunction (ND). Results: For 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. Conclusions: In our study, we found that b-ACP procedure had shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia and neurological dysfunction compared to u-ACP. Meanwhile, we discovered the incidence of ND was independently associated with there factors, including preoperative neurological dysfunction, CPB time and type of cerebral perfusion.

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Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral

BMC Surgery ◽

10.1186/s12893-020-00957-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Zhengqin Liu ◽

Chen Wang ◽

Xiquan Zhang ◽

Shuming Wu ◽

Changcun Fang ◽

...

Keyword(s):

Aortic Dissection ◽

Lower Incidence ◽

Cerebral Perfusion ◽

Type A ◽

Neurological Complications ◽

Neurological Dysfunction ◽

Acute Type ◽

Type A Aortic Dissection ◽

Neurologic Dysfunction ◽

Ventilation Time

Abstract Background 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. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. Methods 321 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). Results For 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. Conclusions In 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.

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