Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring complex surgical repair.
• Cerebral perfusion strategies, including unilateral (uni-ACP) and bilateral (bi-ACP) antegrade cerebral perfusion, are critical for protecting brain function during ATAAD surgery.
• Optimal perfusion strategy remains a subject of ongoing research and clinical debate.

Purpose of the Study:

• To compare the short- and long-term clinical outcomes of uni-ACP versus bi-ACP in patients undergoing surgical repair for ATAAD.
• To evaluate the efficacy of both perfusion techniques in preventing neurological complications and improving survival rates.
• To determine if uni-ACP offers advantages in terms of simplicity or reduced perioperative complications.

Main Methods:

• A retrospective analysis of 307 patients who underwent surgical repair of ATAAD between 2001 and 2017.
• Patients were divided into two groups based on the perfusion strategy used: uni-ACP (n=140) and bi-ACP (n=167).
• Data were collected from a cardiac surgery data warehouse, medical records, and the National Death Index, analyzing perioperative outcomes, stroke rates, and long-term survival.

Main Results:

• Demographics and comorbidities were similar between uni-ACP and bi-ACP groups.
• Perioperative outcomes, including 30-day mortality and overall stroke rates, were not significantly different between the groups.
• Reoperation for bleeding was significantly lower in the uni-ACP group (5% vs. 12%, P=.03), and mid-term survival was better in the uni-ACP group (5-year survival: 84% vs. 76%, P=.027).

Conclusions:

• Both uni-ACP and bi-ACP are effective in brain protection during ATAAD repair, with comparable low rates of postoperative stroke and mortality.
• Uni-ACP is associated with a lower rate of reoperation for bleeding and better mid-term survival.
• Uni-ACP is recommended due to its simplicity and reduced manipulation of arch branch vessels, making it a favorable option for hemiarch to zone 3 arch replacement in ATAAD.