Extracorporeal Off-Pump Antegrade Cerebral Perfusion in Reconstructive Surgery for Type A Aortic Dissection With...

Area of Science:

• Cardiovascular Surgery
• Neurology
• Vascular Surgery

Background:

• Type A aortic dissection (TAAD) frequently causes cerebral malperfusion (CM), leading to neurological damage.
• Traditional cardiopulmonary bypass (CPB) with antegrade cerebral perfusion (ACP) carries risks like embolism and interrupted blood flow.
• Protecting cerebral circulation during aortic arch repair in TAAD patients with CM is critical.

Purpose of the Study:

• To evaluate an innovative off-pump axillo-axillary shunt for continuous cerebral perfusion during TAAD repair with CM.
• To assess the safety and efficacy of this technique compared to traditional CPB methods.
• To reduce neurological complications and operative risks in high-risk TAAD patients.

Main Methods:

• 18 patients with TAAD and CM underwent branch-first stage total aortic arch replacement (BF-TAR) using an axillo-axillary shunt for ACP.
• The shunt provided uninterrupted bihemispheric cerebral perfusion, bypassing traditional CPB.
• Outcomes included operative mortality, neurological complications, CPB times, and overall morbidity.

Main Results:

• The axillo-axillary shunt ensured stable, continuous ACP in all patients, with no new permanent neurological deficits.
• Transient neurological symptoms occurred in 27.8% but resolved within 48 hours.
• Operative mortality was 5.6%, with manageable minor complications; CPB times were significantly reduced compared to literature averages.

Conclusions:

• The off-pump axillo-axillary shunt is a safe and effective technique for maintaining cerebral perfusion during TAAD repair with CM.
• This method mitigates CPB-related risks, improving neurological and surgical outcomes.
• Further research with larger cohorts is recommended to confirm long-term benefits.