Unilateral versus bilateral anterograde cerebral perfusion in acute type A aortic dissection repair: A systematic review and meta-analysis

Tasoudis, Panagiotis; Varvoglis, Dimitrios N.; Vitkos, Evangelos; Ikonomidis, John S.; Athanasiou, Thanos

doi:10.1177/02676591221095468

Cited by 5 publications

(5 citation statements)

References 23 publications

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“…These findings align with previous meta-analysis reports. [25][26][27] However, TND were less frequent in the BCP group, indicating a potential benefit of BCP in reducing the risk of early neurological complications. Furthermore, subgroup analyses revealed intriguing findings when considering the extent of aortic replacement.…”

Section: Discussionmentioning

confidence: 92%

“…By focusing exclusively on patients undergoing aortic surgery for type A aortic dissection, we aimed to reduce heterogeneity related to surgical indication and aortic pathology. Our study provides an updated analysis with an increased number of studies compared with the previous meta-analysis conducted by Tasoudis et al, 25 which included eight studies. Our analysis focused on specific outcomes directly related to cerebral protection.…”

Section: Discussionmentioning

confidence: 98%

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Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection

Naito,

Takagi

2024

Thorac Cardiovasc Surg

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Background This meta-analysis compared the outcomes of bilateral cerebral perfusion (BCP) and unilateral cerebral perfusion (UCP) in aortic surgery for acute type A aortic dissection. Methods A systematic literature search identified 12 studies involving 4,547 patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative neurological complications. Results No significant differences were found between the BCP and UCP groups in terms of cardiopulmonary bypass time, aortic cross clamp time, lowest body temperature, and lower body circulatory arrest time. Short-term mortality rates (OR [95% CI] = 0.87 [0.64–1.19], p = 0.40) and permanent neurological deficits (OR [95% CI] = 1.01 [0.69–1.47], p = 0.96) were comparable between the groups. However, subgroup analysis of studies exclusively involving total arch replacement showed a lower short-term mortality rate (OR [95% CI] = 0.42 [0.28–0.63], p < 0.01) and permanent neurological deficits (OR [95% CI] = 0.53 [0.30–0.92], p = 0.03) in the BCP group. The BCP group also had a lower rate of temporary neurological deficits (OR [95% CI] = 0.70 [0.53–0.93], p = 0.01), particularly in studies exclusively involving total arch replacement (OR [95% CI] = 0.58 [0.40–0.85], p < 0.01). Conclusion This meta-analysis suggests that BCP and UCP yield comparable outcomes. However, BCP may be associated with lower short-term mortality rates and reduced incidence of neurological complications, particularly in cases requiring total arch replacement. BCP should be considered as a preferred cerebral perfusion in specific patient populations.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection

Naito,

Takagi

2024

Thorac Cardiovasc Surg

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“…Furthermore, implementing effective brain protection measures during surgery is challenging for the surgical procedure and postoperative recovery. 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 ).…”

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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“…The method of cerebral perfusion during the s-TAR technique was BACP, while UACP was mainly used in the c-TAR technique, converting to BACP only when deemed necessary. Many studies comparing UACP to BACP demonstrated that UACP offered as much cerebral and visceral organ protection as BACP [19][20].…”

Section: Discussionmentioning

confidence: 99%

“…3. A two-cavity adult urinary catheter (20)(21)(22) Fr, Lusheng Medical Co, Ltd, Shandong, China) (Figure 4)…”

Section: S-tar Techniquementioning

confidence: 99%

Early outcome of simplified total arch reconstruction under mild hypothermia (30-32°C) with distal aortic perfusion

Zheng

Liu

et al. 2023

Preprint

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Objective We designed a simplified total arch reconstruction (s-TAR) technique which could be performed under mild hypothermia (30–32°C) with distal aortic perfusion. This study aimed to compare its efficacy of organ protection with the conventional total arch reconstruction (c-TAR). Methods We reviewed the clinical data of 195 patients who had ascending aortic aneurysm with extended aortic arch dilation and underwent simultaneous ascending aorta replacement and TAR procedure between January 2018 and December 2022 in our center. 105 received c-TAR under moderate hypothermia (25–28°C) with circulatory arrest (c-TAR group); rest 90 received s-TAR under mild hypothermia (30–32°C) with distal aortic perfusion (s-TAR group). Results The s-TAR group demonstrated shorter CPB time, cross-clamp time and lower body circulatory arrest time compared with the c-TAR group. The 30-day mortality was 2.9% for the c-TAR group and 1.1% for the s-TAR group (P = 0.043). The mean duration of mechanical ventilation was shorter in the s-TAR group. Paraplegia was observed in 4 of 105 patients (3.8%) in the c-TAR group, while no such events were observed in the s-TAR group. The incidence of temporary neurologic dysfunction was significantly higher in the c-TAR group. The incidence of permanent neurologic dysfunction also showed a tendency to be higher in the c-TAR group, without statistical significance. Furthermore, the incidence of reoperation for bleeding were significantly lower in the s-TAR group. The rate of postoperative hepatic dysfunction and all grades of AKI was remarkably lower in the s-TAR group. The 3-year survival rate was 95.6% in the s-TAR group and 91.4% in the c-TAR group. Conclusions s-TAR under mild hypothermia (30–32℃) with distal aortic perfusion is associated with lower mortality and morbidity, offering better neurological and visceral organ protection compared with c-TAR.

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Unilateral versus bilateral anterograde cerebral perfusion in acute type A aortic dissection repair: A systematic review and meta-analysis

Cited by 5 publications

References 23 publications

Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection

Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection

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

Early outcome of simplified total arch reconstruction under mild hypothermia (30-32°C) with distal aortic perfusion

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