Cerebral Protection Strategies and Stroke in Surgery for Acute Type A Aortic Dissection

Pitts, Leonard; Kofler, Markus; Montagner, Matteo; Heck, Roland; Iske, Jasper; Buz, Semih; Kurz, Sabine; Starck, Christoph; Falk, Volkmar; Kempfert, Jörg

doi:10.3390/jcm12062271

Cited by 15 publications

(9 citation statements)

References 82 publications

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“…While bACP is suggested for longer CA durations, uACP is safe for shorter durations. There is no definitive time threshold established, but 30–50 min has been proposed ( 48 ). Besides, RCP is the less complicated method and can be performed in more centers and by most surgeons, as well as with minimal procedures, without an increase in CPB, CA, or hospital stay time.…”

Section: Discussionmentioning

confidence: 99%

Cerebral protection in acute type A aortic dissection surgery: a systematic review and meta-analysis

Rahimi,

Sahrai,

Norouzi

et al. 2024

J Thorac Dis

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Background Acute type A aortic dissection (ATAAD) still challenges physicians and warrants emergent surgical management. Two main methods to reduce cerebrovascular events in ATAAD surgeries are antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). We conducted a systematic review and meta-analysis to compare the outcomes of ACP and RCP methods during the ATAAD surgery. Methods In this study, we searched the databases until March 29 th , 2023. Studies that reported the data for comparison of different types of brain perfusion protection during aortic surgery in patients with ATAAD were included. Results Twenty-six studies met the eligibility criteria. All studies had a low risk of bias as they were evaluated by the Joanna Briggs Institute (JBI) critical appraisal tool. Eventually, we included 26 studies in the current meta-analysis, and a total of 13,039 patients were evaluated. The calculated risk ratio (RR) for permanent neurologic dysfunction (PND) in ACP and RCP comparison was RR =1.23, 95% confidence interval (CI): (0.84, 1.80) (P value =0.2662), and in unilateral ACP (uACP) and bilateral ACP (bACP) was RR =1.2786, 95% CI: (0.7931, 2.0615) (P value =0.3132). When comparing the ACP-RCP and uACP-bACP groups, significant differences were found between ACP-RCP the groups in terms of circulatory arrest time (P value =0.0017 and P value =0.1995, respectively), cardiopulmonary bypass time (P value =0.5312 and P value =0.7460, respectively), intensive care unit (ICU)-stay time (P value =0.2654 and P value =0.0099), crossclamp time (P value =0.6228 and P value =0.2625), and operative mortality (P value =0.9368 and P value =0.2398, respectively), and when comparing the u-ACP and b-ACP groups for transient neurologic deficit (TND), an RR of 1.32, 95% CI: (1.05, 1.67) (P value =0.0199). The results showed high heterogeneity and no publication bias. Conclusions This study demonstrated that the ACP and RCP are both safe and acceptable techniques to use in emergent settings. The uACP technique is equivalent to bACP in terms of PND and mortality, however, uACP is preferred over bACP in terms of TND.

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Section: Discussionmentioning

confidence: 99%

Cerebral protection in acute type A aortic dissection surgery: a systematic review and meta-analysis

Rahimi,

Sahrai,

Norouzi

et al. 2024

J Thorac Dis

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“…Currently, there is no clear definition in the academic community regarding whether intraoperative brain protection involves selective or bilateral cerebral perfusion ( 14 ). Neurological complications are a common phenomenon after surgery ( 15 ). Postoperatively, delayed wakefulness, vision problems, and strokes often occur.…”

Section: Discussionmentioning

confidence: 99%

Aortic arch branch-prioritized reconstruction for type A aortic dissection surgery

Gao,

Yan,

Duan

et al. 2024

Front. Cardiovasc. Med.

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BackgroundAcute Stanford type A aortic dissection (STAAD) is a fatal condition requiring urgent surgical intervention. Owing to the complexity of the surgical process, various complications, such as neurological disorders, are common. In this study, we prioritized the reconstruction of aortic arch branches during surgery and investigated the association between prioritizing the branches and the postoperative outcomes of patients with STAAD.MethodsNinety-seven patients were included in the observational study and underwent total arch replacement and frozen elephant trunk technique between January 2018 and June 2021. Of these, 35 patients underwent the branch-priority technique, and 62 patients underwent the classic technique. By analyzing the perioperative outcomes, we compared the differences between the two techniques.ResultsThe branch priority group had significantly shorter cardiopulmonary bypass and ventilator times and earlier postoperative wake-up times than the classic group. Additionally, the ICU stay time was shorter, with a significant decrease in neurological complications and 24 h drainage in the branch priority group compared to the classic group.ConclusionThe branch priority technique can effectively provide better brain protection, resulting in earlier awakening of patients after surgery, reduced neurological complications, shorter ventilation time and decreased ICU hospitalization time. Therefore, it is recommended for use in aortic dissection surgeries.

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“…Stroke is commonly seen after open aortic repair of ATAAD [ 19 ]. In the present study, the incidence of stroke was 8.8%.…”

Section: Discussionmentioning

confidence: 99%

Postoperative thrombocytopenia and subsequent consequences in acute type A aortic dissection

Tang,

Shao

2023

Annals of Medicine

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Objectives To ascertain if postoperative thrombocytopenia following open aortic surgery with a median sternotomy can predict early- and intermediate-term morbidity and mortality. Methods From January 2018 to December 2022, a comparison was made between patients who had and didn’t have postoperative thrombocytopenia (defined as a nadir < 75 × 103/μL after 72 h of open aortic surgery with median sternotomy). Intermediate-term mortality during follow-up was the main result, with cerebrovascular accident and acute renal injury requiring dialysis as secondary events. Inverse probability treatment weighting (IPTW) was used to account for selection bias between groups. The Kaplan-Meier method with the log-rank test was used to assess intermediate-term survivals following IPTW modification. To identify the nonlinear link between platelet nadir and mortality probability, a generalized additive mix model was applied. To help increase power in testing for the overall effect of platelet nadir on outcomes in the generalized additive mix model, the hazard ratios and 95% CIs for each subgroup and their interactions were examined. Results The study included 457 patients, 347 male (75.9%), with mean age of 54 ± 12 years. The last follow-up was done on April 14 th , 2023 and the median follow-up time was 16 (6-31) months. Following IPTW, patient characteristics were balanced among cohorts. Platelet nadir was found to be significantly inversely related to early-term mortality (IPTW-adjusted hazard ratio = 0.968 (0.960, 0.977), p < 0.001), and AKI requiring dialysis (IPTW-adjusted hazard ratio = 0.979 (0.971, 0.986), p < 0.001). A nonlinear relationship between platelet nadir and mortality risk probability during follow-up visually showed that the likelihood of mortality decreased with platelet nadir increased. In confounder-adjusted survival (‘postoperative thrombocytopenia not acquired’ vs ‘postoperative thrombocytopenia’; HR: 0.086 [95% CI: 0.045-0.163]; p < 0.01) analysis, non-acquired postoperative thrombocytopenia was associated with a lower risk of mortality, and the treatment benefit was validated in IPTW-adjusted analysis, which showed an HR of 0.067. Conclusions Early postoperative thrombocytopenia following type A aortic dissection surgery is a risk factor for morbidity and mortality. Because postoperative thrombocytopenia can indicate a poor prognosis, monitoring early postoperative platelets helps identify individuals who may develop late postoperative problems, which is performed by this affordable biomarker.

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Cerebral Protection Strategies and Stroke in Surgery for Acute Type A Aortic Dissection

Cited by 15 publications

References 82 publications

Cerebral protection in acute type A aortic dissection surgery: a systematic review and meta-analysis

Cerebral protection in acute type A aortic dissection surgery: a systematic review and meta-analysis

Aortic arch branch-prioritized reconstruction for type A aortic dissection surgery

Postoperative thrombocytopenia and subsequent consequences in acute type A aortic dissection

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