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Comparative study of brain protection in ascending aorta replacement for acute type A aortic dissection: retrograde cerebral perfusion versus selective antegrade cerebral perfusion

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Abstract

Objectives

Postoperative disorders of the central nervous system remain a major problem in thoracic aortic surgery. Both retrograde cerebral perfusion and selective antegrade cerebral perfusion have become established techniques for cerebral circulatory management. In this study, we compared neurologic outcomes and mortality between retrograde cerebral perfusion and antegrade selective cerebral perfusion in patients with acute type A aortic dissection who underwent emergency ascending aorta replacement.

Methods

Between January 2003 and April 2011, a total of 203 patients with acute type A aortic dissection underwent emergency ascending aorta replacement in our hospital. We performed retrograde cerebral perfusion in 109 patients before 2006, and then mainly performed antegrade selective cerebral perfusion in 94 patients from 2006 onward.

Results

Cardiopulmonary bypass time and systemic circulatory arrest time were significantly longer in the antegrade selective cerebral perfusion group (p = 0.04, p < 0.001, respectively). The incidences of transient brain dysfunction and permanent brain dysfunction after surgery did not differ significantly between the groups. There were also no differences between the groups in other intraoperative variables, such as aortic cross-clamp time and the lowest rectal temperature, or in operative outcomes, including postoperative intensive-care-unit stay, mean peak amylase, and lipase levels until postoperative day 7, and 30-day mortality.

Conclusion

Both retrograde cerebral perfusion and antegrade selective cerebral perfusion were associated with acceptable levels of postoperative neurologic deficits, mortality, and morbidity. Either of these techniques for brain protection can be used selectively, based on a comprehensive assessment of general condition, in patients undergoing surgery for acute type A aortic dissection.

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References

  1. Usui A, Miyata H, Ueda Y, Motomura N, Takamoto S. Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery: based on the Japan adult cardiovascular surgery database : the Japan cardiovascular surgery database organization. Gen Thorac Cardiovasc Surg. 2012;60:132–9.

    Article  PubMed  Google Scholar 

  2. Okita Y, Minatoya K, Tagusari O, Ando M, Nagatsuka K, Kitamura S. Prospective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg. 2001;72:72–9.

    Article  CAS  PubMed  Google Scholar 

  3. Hagl C, Ergin MA, Galla JD, Lansman SL, McCullough JN, Spielvogel D, et al. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg. 2001;121:1107–21.

    Article  CAS  PubMed  Google Scholar 

  4. Griepp RB. Cerebral protection during aortic arch surgery. J Thorac Cardiovasc Surg. 2001;121:425–7.

    Article  CAS  PubMed  Google Scholar 

  5. Khaladj N, Shrestha M, Meck S, Peterss S, Kamiya H, Kallenbach K, et al. Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients. J Thorac Cardiovasc Surg. 2008;135:908–14.

    Article  PubMed  Google Scholar 

  6. Ergin MA, Uysal S, Reich DL, Apaydin A, Lansman S, McCullough JN, et al. Temporary neurological dysfunction after deep hypothermic circulatory arrest: a clinical marker of long-term functional deficit. Ann Thorac Surg. 1999;67:1887–90.

    Article  CAS  PubMed  Google Scholar 

  7. Kamiya H, Hagl C, Kropivnitskaya I, Bothig D, Kallenbach K, Khaladj N, et al. The safety of moderate hypothermic lower body circulatory arrest with selective cerebral perfusion: a propensity score analysis. J Thorac Cardiovasc Surg. 2007;133:501–9.

    Article  PubMed  Google Scholar 

  8. Milewski RK, Pacini D, Moser W, Moeller P, Cowie D, Szeto WY, et al. Retrograde and antegrade cerebral perfusion: results in short elective arch reconstructive times. Ann Thorac Surg. 2010;89:1448–57.

    Article  PubMed  Google Scholar 

  9. Bavaria JE, Brinster DR, Gorman RC, Woo YJ, Gleason T, Pochettino A. Advances in the treatment of acute type A dissection: an integrated approach. Ann Thorac Surg. 2002;74:1848–52.

    Article  Google Scholar 

  10. Bakhtiary F, Dogan S, Zierer A, Dzemali O, Oezaslan F, Therapidis P, et al. Antegrade cerebral perfusion for acute type A aortic dissection in 120 consecutive patients. Ann Thorac Surg. 2008;85:465–9.

    Article  PubMed  Google Scholar 

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Correspondence to Tadahisa Sugiura.

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Sugiura, T., Imoto, K., Uchida, K. et al. Comparative study of brain protection in ascending aorta replacement for acute type A aortic dissection: retrograde cerebral perfusion versus selective antegrade cerebral perfusion. Gen Thorac Cardiovasc Surg 60, 645–648 (2012). https://doi.org/10.1007/s11748-012-0142-z

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  • DOI: https://doi.org/10.1007/s11748-012-0142-z

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