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Optimal antegrade cerebral perfusion flow in patients undergoing surgery for acute type A aortic dissection: A
Matthijs Gerritse1, Thomas J van Brakel2, Joris van Houte3
1Department of Extracorporeal Circulation, Catharina Hospital, Eindhoven, The Netherlands.
Insights
This study found no correlation between antegrade selective cerebral perfusion (ASCP) flow rate and regional cerebral oxygen saturation (rSO2) in type A aortic dissection surgery. Lower ASCP flow rates did not significantly impact brain oxygenation.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Critical Care Medicine
Background:
- Systemic hypothermia with bilateral antegrade selective cerebral perfusion (ASCP) is standard for type A aortic dissection repair.
- Optimal ASCP flow rates for cerebral protection are not well-defined.
- Pressure limitations can hinder achieving target ASCP flow rates.
Purpose of the Study:
- To investigate the relationship between ASCP flow rate and regional cerebral oxygen saturation (rSO2).
- To determine if lower ASCP flow rates impact cerebral oxygenation during type A aortic dissection surgery.
Main Methods:
- Retrospective analysis of 140 patients undergoing type A aortic dissection repair with moderate hypothermic circulatory arrest and bilateral ASCP.
- Pearson correlation analysis was used to assess the association between ASCP flow and rSO2.
- Comparison of rSO2 values between patients receiving high (>10 mL/kg/min) versus lower ASCP flow rates.
Main Results:
- No significant correlation was found between ASCP flow rate and rSO2 in either cerebral hemisphere.
- ASCP flow rates below 10 mL/kg/min were not associated with reduced rSO2.
- No significant difference in rSO2 was observed between patients receiving >10 mL/kg/min and ≤10 mL/kg/min ASCP flow.
Conclusions:
- ASCP flow rate does not correlate with rSO2 in patients with acute type A aortic dissection.
- ASCP flow below 10 mL/kg/min appears safe regarding cerebral oxygenation.
- Further research is needed to establish definitive links between ASCP flow and neurological outcomes.
Background:
Systemic hypothermia with bilateral antegrade selective cerebral perfusion (ASCP) is the preferred cerebral protective strategy for type A aortic dissection surgery. The optimal ASCP flow rate remains uncertain and the target flow cannot always be reached due to pressure limitations. The aim of this study was to assess the correlation between ASCP flow and regional cerebral oxygen saturation (rSO2).
Methods:
A retrospective analysis was performed on 140 patients with acute type A aortic dissection who underwent surgery with moderate hypothermic circulatory arrest and bilateral ASCP between 2015 and 2021. Pearson correlation analysis was performed between ASCP flow and rSO2.
Results:
The median circulatory arrest duration was 46.5 (IQR:37.0-61.0) minutes. There was no significant correlation between ASCP flow and rSO2 for both the right (r = -.02, p = .851), and the left hemisphere (r = - .04, p = .618). The rSO2 values for ten patients who received > 10 mL/kg/min flow did not differ significantly from 130 patients who received 10 mL/kg/min or less for both the left hemisphere (p = .135), and the right hemisphere (p = .318). The ASCP flow was 5.1 (IQR:5.0- 6.5) mL/kg/min in five patients with, and 7.2 (IQR:5.8-8.3) mL/kg/min in 135 patients without a watershed infarction (p = .098).
Conclusions:
There was no correlation between ASCP flow rate and rSO2 in patients with acute type A aortic dissection. Furthermore, ASCP flow below 10 mL/kg/min was not associated with a reduction in rSO2. Definitive associations between ASCP flow and neurological outcome after type A aortic dissection surgery need further investigation.
