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Published on: February 17, 2013
Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a
Antonio Piperata1,2, Masazumi Watanabe3, Mathieu Pernot2
1Department of Cardiology, Thoracic, Vascular, and Public Health Sciences, University of Padua, Padova, Italy.
Insights
Unilateral antegrade cerebral perfusion (ACP) may offer advantages over bilateral ACP for type A aortic dissection surgery, showing reduced complications and shorter procedure times without impacting mortality or survival.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Thoracic Surgery
Background:
- Type A aortic dissection requires complex surgical repair involving the aortic arch.
- Cerebral protection strategies, such as antegrade cerebral perfusion (ACP), are crucial during aortic arch surgery.
- Comparing unilateral and bilateral ACP techniques is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare the clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies.
- To evaluate the effectiveness of these strategies in providing cerebral protection during type A aortic dissection surgery.
Main Methods:
- Retrospective analysis of 646 patients undergoing type A aortic dissection repair (2008-2018).
- Comparison of unilateral (n=250) and bilateral (n=396) ACP techniques under moderate hypothermic circulatory arrest.
- Propensity score matching created 189 matched pairs for robust outcome assessment.
Main Results:
- Unilateral ACP was associated with significantly shorter aortic cross-clamp (82 vs. 100 min) and cardiopulmonary bypass times (170 vs. 195 min).
- The bilateral ACP group showed a higher incidence of permanent neurologic deficits (P<0.001) and all-combined complications (P<0.001).
- 30-day mortality and 10-year survival rates were comparable between the two groups.
Conclusions:
- Both unilateral and bilateral ACP are viable brain protection strategies for aortic arch surgery.
- The unilateral ACP technique may provide clinical advantages, including reduced complications and shorter operative times.
- Further research is warranted to fully elucidate the benefits of unilateral ACP.
Objectives:
The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection.
Methods:
Data from 646 patients who underwent surgical repair of thoracic type A aortic dissection using unilateral and bilateral ACP with moderate hypothermic circulatory arrest in 3 cardiac surgical institutions between 2008 and 2018 were analysed. Propensity matching was performed to assess which technique ensured better outcomes.
Results:
Unilateral and bilateral ACP techniques were performed in 250 (39%) and in 396 (61%) patients, respectively. Propensity score analysis identified 189 matched pairs. In the matched cohort, the lowest core temperature was 27.5°C and 28°C in the bilateral and unilateral groups, respectively (P < 0.001). The unilateral technique required significantly shorter aortic cross-clamp and cardiopulmonary bypass times than bilateral technique [82 min vs 100 min (P < 0.001); 170 min vs 195 min (P < 0.001)]. The 30-day mortality was comparable (P = 0.325). The bilateral group reported a significantly higher incidence of permanent neurologic deficits (P < 0.001), left brain hemisphere stroke (P = 0.007) and all-combined complications (P < 0.001). Ten-year survival was comparable (P = 0.45).
Conclusions:
Unilateral and bilateral ACP are both valid brain protection strategies in the landscape of aortic arch surgery. While admitting all the study limitations, unilateral technique could offer some clinical advantages.
Clinical Registration Number:
76049.
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