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Selective antegrade cerebral perfusion during aortic arch surgery confers survival and neuroprotective advantages
Mohammad Shihata1, Rohan Mittal, A Senthilselvan
1Division of Cardiac Surgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. mshihata@gmail.com
Insights
Antegrade cerebral perfusion during aortic arch surgery significantly improves patient survival and reduces stroke risk. This technique is particularly beneficial for complex aortic arch repairs, enhancing neurologic outcomes.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Critical Care Medicine
Background:
- Aortic arch surgery carries risks of stroke and mortality.
- Optimizing perfusion strategies is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effect of antegrade cerebral perfusion (ACP) on survival and neurologic outcomes in aortic arch surgery.
- To compare outcomes between patients who received ACP and those who did not.
Main Methods:
- Retrospective comparison of 46 patients with ACP and 78 patients without ACP during aortic arch surgery.
- Statistical analysis using logistic regression and Cox proportional hazards models.
- Assessment of postoperative cerebrovascular complications, mechanical ventilation duration, and 3-year survival.
Main Results:
- ACP group showed significantly lower rates of postoperative cerebrovascular complications (2% vs. 13%, P=.03).
- Patients receiving ACP had shorter mechanical ventilation durations (1.15 vs. 2.13 days, P=.02).
- Three-year survival was significantly higher in the ACP group (93% vs. 78%, P=.03).
Conclusions:
- Antegrade cerebral perfusion is associated with improved survival and neurologic outcomes in aortic arch surgery.
- ACP is a significant predictor of reduced stroke rates and enhanced midterm survival.
- The benefits of ACP are particularly notable in prolonged aortic arch repair procedures.
Objective:
To assess the impact of using antegrade cerebral perfusion during aortic arch surgery on postoperative survival and neurologic outcomes.
Methods:
All operations were performed at the same hospital between January 2001 and January 2009. Patients undergoing aortic arch surgery using antegrade cerebral perfusion during deep hypothermia were compared with patients undergoing aortic arch surgery without antegrade cerebral perfusion during the same study period. Multivariable logistic regression and Cox proportional hazards model were used to identify predictors of postoperative cerebrovascular accidents and midterm survival, respectively. There were 46 patients in the antegrade cerebral perfusion group and 78 patients in the non-antegrade cerebral perfusion group.
Results:
There were no statistically significant differences in age, proportion of emergency operations, or proportion of type A aortic dissection between the 2 groups. There was a statistically significant and clinically important difference in the rates of postoperative cerebrovascular complications (2% antegrade cerebral perfusion vs 13% non-antegrade cerebral perfusion, P = .03), postoperative duration of mechanical ventilation (1.15 ± 0.19 days antegrade cerebral perfusion vs 2.13 ± 0.38 days non-antegrade cerebral perfusion, P = .02), and 3-year survival (93% antegrade cerebral perfusion vs 78% non-antegrade cerebral perfusion, P = .03). Antegrade cerebral perfusion was shown to be a significant predictor of reduced postoperative stroke rates and better survival at 3 years.
Conclusions:
Antegrade cerebral perfusion was associated with improved survival and neurologic outcomes in patients undergoing aortic arch surgery, especially for cases requiring prolonged aortic arch repair periods.
