Cerebral protection in extended arch repair for acute type A aortic dissection

To evaluate the association between cerebral perfusion strategy and neurologic outcomes following extended arch repair for acute type A aortic dissection (ATAAD).

We identified patients who underwent extended arch repair for ATAAD at our institution between 2002 and 2024. Patients were stratified by cerebral perfusion strategyL antergrade certebral perfusion (ACP) or retrograde cerebral perfusion (RCP). Outcomes included stroke and a composite of 30-day mortality, stroke, and temporary neurologic dysfunction. Multivariable analysis was used to evaluate the association between cerebral perfusion strategy and the composite outcome.

A total of 206 patients met the study inclusion criteria (median age, 58.7 years; 25.2% female). ACP was the most common cerebral perfusion strategy (58.7%; n = 121), followed by combined ACP and RCP (32.0%; n = 66) and then RCP (9.2%; n = 19). The median circulatory arrest time was longer in cases using combined ACP and RCP (62 minutes) compared to ACP (38 minutes) or RCP (34 minutes) (P < .001). Permanent stroke occurred in 22 patients (10.7%) and did not differ by cerebral perfusion strategy. The composite outcome occurred in 53 patients (25.7%), with the highest frequency in the combined group, although the difference was not significant on pairwise comparison. On adjusted analysis, cerebral perfusion strategy was not an independent predictor of the composite outcome.

Despite prolonged circulatory arrest times, cases using combined ACP and RCP were not associated with an increased rate of stroke. The combined approach may help extend the safe duration of circulatory arrest in extended arch repair for ATAAD.