Unilateral vs. Bilateral Selective Cerebral Perfusion for Acute Type A Aortic Dissection with Frozen Elephant Trunk:...

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Vascular Surgery

Background:

• Optimal cerebral perfusion strategy during total aortic arch replacement with frozen elephant trunk (FET) for acute type A aortic dissection (ATAAD) remains debated.
• Previous studies have not definitively established the superiority of unilateral versus bilateral selective antegrade cerebral perfusion (SACP).

Purpose of the Study:

• To compare clinical outcomes of unilateral (uSACP) versus bilateral (bSACP) selective antegrade cerebral perfusion (SACP) in patients undergoing total aortic arch replacement with FET for ATAAD.
• To investigate the impact of SACP strategy on mortality and postoperative complications.

Main Methods:

• Systematic review and meta-analysis of studies published until May 2023.
• Inclusion of 44 papers encompassing 5983 patients (3872 uSACP, 2111 bSACP) with ATAAD undergoing FET repair.
• Analysis of mortality, major postoperative complications, and neurological complications.

Main Results:

• No significant difference in mortality or major postoperative complications between uSACP and bSACP groups, despite higher comorbidities in the bSACP group.
• Longer SACP times were associated with increased neurological complications.
• Significantly increased mortality was observed with prolonged unilateral SACP.

Conclusions:

• Current practices suggest centers tailor SACP strategies to individual patient complexity for FET repair in ATAAD.
• A personalized approach to SACP is more critical than seeking a universally superior technique.
• Further research is needed to validate these findings and refine perfusion strategies.