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Updated: Apr 20, 2026
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Unilateral versus bilateral cerebral perfusion for acute type A aortic dissection
Ourania Preventza1, Katherine H Simpson2, Denton A Cooley3
1Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas; Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Unilateral antegrade cerebral perfusion (u-ACP) and bilateral antegrade cerebral perfusion (b-ACP) show similar outcomes for acute type A aortic dissection. Survival remains the key metric, with u-ACP offering technical simplicity and b-ACP potentially beneficial for longer circulatory arrest times.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Surgery
Background:
- Antegrade cerebral perfusion (ACP) is a standard technique for complex aortic pathologies, with unilateral (u-ACP) and bilateral (b-ACP) approaches.
- This study focuses on proximal acute type A aortic dissection, comparing the clinical outcomes of u-ACP and b-ACP.
Purpose of the Study:
- To investigate and compare the clinical efficacy of unilateral (u-ACP) versus bilateral antegrade cerebral perfusion (b-ACP) in patients with acute type A aortic dissection.
Main Methods:
- A retrospective analysis of 157 consecutive patients with acute type A aortic dissection from January 2005 to May 2013.
- 153 patients underwent ACP, with 90 receiving u-ACP and 63 receiving b-ACP. Systemic hypothermia was maintained at 22°–24°C.
- Key procedural times (ACP, cardiopulmonary bypass, cardiac ischemia) and clinical outcomes (mortality, stroke, renal failure) were analyzed.
Main Results:
- Operative mortality was similar between u-ACP (13.3%) and b-ACP (12.7%) groups (p=0.91).
- Postoperative stroke rates were also comparable: 14.8% for u-ACP and 12.9% for b-ACP survivors (p=0.75).
- Circulatory arrest times exceeding 30 minutes were associated with an increased risk of stroke (p=0.031).
Conclusions:
- Both u-ACP and b-ACP demonstrate similar rates of operative mortality, stroke, temporary neurologic dysfunction, and renal failure in type A aortic dissection.
- u-ACP may offer technical advantages for surgeons, while b-ACP might be considered for procedures requiring extended circulatory arrest (>30 minutes).
- Survival is paramount in managing this complex disease, and both ACP techniques are viable options.
