Unilateral or bilateral cerebral perfusion in hemiarch replacement: A prospective randomized study

Area of Science:

• Cardiovascular Surgery
• Neurology
• Medical Imaging

Background:

• Ascending aortic aneurysms necessitate complex surgical repair.
• Antegrade cerebral perfusion (ACP) is crucial for brain protection during aortic arch surgery.

Purpose of the Study:

• To compare the efficacy of unilateral versus bilateral antegrade cerebral perfusion (ACP) under moderate hypothermia.
• To evaluate the impact of ACP techniques on neurological outcomes and mortality in patients undergoing open distal aortic hemiarch replacement.

Main Methods:

• A prospective randomized clinical study involving 42 patients with ascending aortic aneurysms.
• Patients were randomized to receive either unilateral or bilateral ACP.
• Outcomes assessed included permanent neurological disorder, death, and postoperative MRI findings.

Main Results:

• No significant demographic differences were observed between the unilateral and bilateral ACP groups.
• Bilateral ACP involved significantly longer perfusion times (18.23 min) compared to unilateral ACP (12.62 min).
• No permanent neurological disorders or mortality occurred; however, transient neurological events and ischemic zones on MRI were observed in the unilateral group.

Conclusions:

• The study did not demonstrate a significant difference in cerebral protection between unilateral and bilateral ACP.
• The relatively short overall antegrade cerebral perfusion (ACP) times may have limited the ability to detect superiority between the techniques.
• Further research with longer perfusion durations may be needed to clarify the optimal ACP strategy.