Meta-analysis: Bilateral and Unilateral Cerebral Perfusion in Type A Dissection
Noritsugu Naito1, Hisato Takagi1
1Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan.
The Thoracic and Cardiovascular Surgeon
|January 30, 2024
Summary
Bilateral cerebral perfusion (BCP) and unilateral cerebral perfusion (UCP) show similar outcomes in aortic surgery. However, BCP may reduce mortality and neurological issues, especially during total arch replacement, making it preferable for certain patients.
Area of Science:
- Cardiovascular Surgery
- Neurological Surgery
Background:
- Acute type A aortic dissection requires complex surgical repair.
- Cerebral perfusion strategies, bilateral (BCP) vs. unilateral (UCP), are critical for patient outcomes.
- Comparing BCP and UCP is essential for optimizing surgical techniques.
Purpose of the Study:
- To compare the outcomes of bilateral cerebral perfusion (BCP) versus unilateral cerebral perfusion (UCP) in patients undergoing aortic surgery for acute type A aortic dissection.
- To analyze differences in perioperative characteristics, short-term mortality, and neurological complications between BCP and UCP.
Main Methods:
- A systematic literature search identified 12 studies with 4,547 patients.
- Meta-analysis using pooled odds ratios (OR) with 95% confidence intervals (CI).
- Analysis of perioperative times, mortality rates, and neurological complications (permanent and temporary deficits).
Main Results:
- Overall, no significant differences in cardiopulmonary bypass time, aortic cross-clamp time, lowest body temperature, or circulatory arrest time were observed between BCP and UCP.
- Short-term mortality (OR 0.87 [0.64-1.19]) and permanent neurological deficits (OR 1.01 [0.69-1.47]) were comparable between the groups.
- Subgroup analysis for total arch replacement showed significantly lower short-term mortality (OR 0.42 [0.28-0.63]) and permanent neurological deficits (OR 0.53 [0.30-0.92]) with BCP.
- BCP was associated with a lower rate of temporary neurological deficits (OR 0.70 [0.53-0.93]), particularly in total arch replacement cases (OR 0.58 [0.40-0.85]).
Conclusions:
- Bilateral cerebral perfusion (BCP) and unilateral cerebral perfusion (UCP) demonstrate comparable overall outcomes in aortic surgery for acute type A aortic dissection.
- BCP may offer advantages, including reduced short-term mortality and fewer neurological complications, particularly in patients requiring total arch replacement.
- BCP should be considered a preferred cerebral perfusion strategy for specific patient populations undergoing complex aortic arch surgery.
