Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, uni
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RESEARCH ARTICLE
Open Access
Effect of different types of cerebral perfusion for acute type A aortic dissection undergoing aortic arch procedure, unilateral versus bilateral Zhengqin Liu1†, Chen Wang2†, Xiquan Zhang2, Shuming Wu2, Changcun Fang2 and Xinyan Pang2*
Abstract Background: Antegrade cerebral perfusion (ACP), including unilateral and bilateral, is most commonly used for cerebral protection in aortic surgery. There is still no consensus on the superiority of the two methods. Our research aimed to investigate the clinical effects of u-ACP and b-ACP. Methods: 321 of 356 patients with type A aortic dissection were studied retrospectively. 124 patients (38.6%) received u-ACP, and 197 patients (61.4%) received b-ACP. We compared the incidence of postoperative neurological complications and other collected data between two groups. Besides, we also analyzed perioperative variables to find the potential associated factors for neurological dysfunction (ND). Results: For u-ACP group, 54 patients (43.5%) had postoperative neurological complications, including 22 patients (17.7%) with permanent neurologic dysfunction (PND) and 32 patients (25.8%) with temporary neurologic dysfunction (TND). For b-ACP group, 47 patients (23.8%) experienced postoperative neurological complications, including 16 patients (8.1%) of PND and 31 patients (15.7%) of TND. The incidence of PND and TND were significantly different between two groups along with shorter CPB time (p = 0.016), higher nasopharyngeal temperature (p≦0.000), shorter ventilation time (p = 0.018), and lower incidence of hypoxia (p = 0.022). Furthermore, multivariate stepwise logistic regression analysis confirmed that preoperative neurological dysfunction (OR = 1.20, p = 0.028), CPB duration (OR = 3.21, p = 0.002), and type of cerebral perfusion (OR = 1.48, p = 0.017) were strongly associated with postoperative ND. Conclusions: In our study, it was observed that b-ACP procedure exhibited shorter CPB time, milder hypothermia, shorter ventilation time, lower incidence of postoperative hypoxia, and neurological dysfunction compared to u-ACP. Meanwhile, the incidence of ND was independently associated with three factors: preoperative neurological dysfunction, CPB time, and type of cerebral perfusion. Keywords: Cerebral protection, Unilateral antegrade cerebral perfusion, Bilateral antegrade cerebral perfusion, Type A aortic dissection, Neurological complications
*Correspondence: [email protected] † Zhengqin Liu and Chen Wang contributed equally to this work and should be considered co-first authors 2 Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Wenhuaxi Road, Jinan 250012, Shandong, China Full list of author information is available at the end of the article
Background Aortic dissection (AD) is one of the most serious cardiac emergencies owing to associated high mortality rates, especially Stanford type A [1, 2]. Presently, surgery is the primary treatment method. The frozen elephant trunk technique is increasingly being used to repair di
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