Related Experiment Video
Updated: Jun 5, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Comparing unilateral and bilateral cerebral perfusion during total arch replacement for acute type A aortic
Yumeng Ji1, Juntao Qiu1, Kai Zhang1
1Department of Vascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Objectives:
To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs. b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET).
Methods:
Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR + FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on ACP: unilateral (n = 402) and bilateral (n = 300). Propensity scores were matched for 217 pairs of patients. Mid-term and perioperative surgical complications were analysed, and baseline characteristics between the two groups were assessed.
Results:
The matched cohort revealed comparable 30-day mortality rates between u-ACP and b-ACP: 4.15% and 3.23%, respectively (P = 0.61). Rates of postoperative permanent neurologic dysfunction (PND) were similar across groups (2.76% for u-ACP and 3.23% for b-ACP, P = 0.76). However, u-ACP exhibited a higher incidence of postoperative transient neurologic deficit (TND) at 14.29% compared to 6.91% with b-ACP (P = 0.01). Logistic regression models identified u-ACP and cardiopulmonary bypass (CPB) time as independent risk factors for TND. Mid-term survival rates were comparable between the two groups (5-year survival: 90.29% vs. 93.67%, P = 0.133).
Conclusions:
Both u-ACP and b-ACP are effective brain protection techniques for ATAAD patients undergoing TAR. The use of b-ACP significantly reduces the incidence of TND.
