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Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study
Jing Lin1, Zhen Qin1, Xinhao Liu1
1Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China.
BMC Cardiovascular Disorders
|April 21, 2021
Summary
Combining retrograde inferior vena caval perfusion (RIVP) with antegrade cerebral perfusion (ACP) may improve outcomes in total aortic arch replacement surgery. This approach showed reduced neurological deficits and shorter recovery times compared to ACP alone.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
- Anesthesiology
- Critical Care Medicine
Background:
- Antegrade cerebral perfusion (ACP) is standard during total aortic arch replacement surgery (TARS) for acute type A aortic dissection.
- However, ACP is linked to significant mortality and morbidity, necessitating alternative perfusion strategies.
- Retrograde inferior vena caval perfusion (RIVP) combined with ACP is explored to potentially enhance patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of combining RIVP with ACP versus ACP alone in patients undergoing TARS.
- To assess the impact of RIVP + ACP on a composite primary outcome of mortality and major complications.
- To investigate secondary outcomes including neurological deficits, intubation duration, and blood product requirements.
Main Methods:
- A prospective, randomized, controlled, assessor-blinded pilot study involving 76 patients scheduled for TARS.
- Patients were randomized to receive either ACP or RIVP + ACP.
- Primary outcome: composite of mortality and major complications (paraplegia, renal failure, liver dysfunction, GI complications). Secondary outcomes: neurological complications, intubation length, blood product use.
Main Results:
- The RIVP + ACP group showed a trend towards lower primary outcome rates (42% vs. 61% in ACP group), though not statistically significant (p=0.31).
- A significantly lower incidence of transient neurological deficits was observed in the RIVP + ACP group (26% vs. 58%, p=0.006).
- The RIVP + ACP group experienced shorter intubation times (25 vs. 47 hours, p=0.022) and required fewer blood products (p=0.047 for red cells, p=0.023 for platelets).
Conclusions:
- Combining RIVP with ACP during TARS may reduce transient neurological deficits, intubation duration, and blood transfusion requirements compared to ACP alone.
- While the primary composite outcome did not reach statistical significance in this pilot study, the observed trends warrant further investigation.
- Larger, multi-center randomized trials are necessary to definitively establish the benefits of RIVP + ACP regarding mortality and major complication rates.
