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Updated: Aug 17, 2026
Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
Adjusted comparison of antegrade cerebral perfusion techniques during prolonged circulatory arrest in surgery for
Leonard Pitts1,2,3, Matteo Montagner1,2, Markus Kofler1,2,3
1Department of Cardiothoracic and Vascular Surgery, German Centre for Cardiovascular Research, Berlin, Germany.
Objective:
To investigate differences in neurologic outcomes between unilateral and bilateral antegrade cerebral perfusion during prolonged circulatory arrest in surgery for acute type A aortic dissection (ATAAD).
Methods:
Patients who underwent surgery for ATAAD between 2013 and 2023 receiving either unilateral antegrade cerebral perfusion (uACP) or bilateral antegrade cerebral perfusion (bACP) during prolonged caudal circulatory arrest (≥30 minutes) were included in the primary study cohort. Preoperative computed tomography scans were analyzed in terms of Type-Entry-Malperfusion classification and supra-aortic dissection patterns. After propensity score matching, the groups were compared in terms of clinical outcomes, including new postoperative strokes.
Results:
A total of 382 patients (206 uACP and 176 bACP) were included. The matched cohort comprised 2 balanced groups with 170 patients (85 in each group). The median circulatory arrest time was 44 (interquartile range [IQR], 36-57) minutes in the uACP group and 44 (IQR, 40-56) minutes in the bACP group (P = .87). Thirty-day mortality occurred in 15 patients (18%) in each group (odds ratio [OR], 1.00; 95% confidence interval [CI], 0.89-1.12; P = 1.00). New postoperative stroke was detected in 6 uACP patients (7%) and in 4 bACP patients (5%) (OR, 0.98; 95% CI, 0.91-1.05; P = .52). Postoperative delirium occurred in 30 uACP patients (35%) and in 35 bACP patients (41%) (OR, 1.06; 95% CI, 0.92-1.23; P = .43).
Conclusions:
Both uACP and bACP are adequate cerebral perfusion strategies during circulatory arrest exceeding 30 minutes in surgery for ATAAD. Additional intraoperative and anatomic factors may be considered to determine the optimal selective cerebral perfusion strategy.