Antegrade and Retrograde Cerebral Perfusion During Acute Type A Aortic Dissection Repair in 290 Patients
| Autor: | Meletios A. Kanakis, Nicholas Giannopoulos, Mazen Khoury, Konstantinos Perreas, Theofani Antoniou, George Samanidis, Marina Balanika, George Stavridis |
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| Rok vydání: | 2020 |
| Předmět: |
Pulmonary and Respiratory Medicine
Perfusion scanning Aorta Thoracic 030204 cardiovascular system & hematology law.invention 03 medical and health sciences 0302 clinical medicine Postoperative Complications law Medicine Humans 030212 general & internal medicine Cerebral perfusion pressure Survival rate Retrospective Studies Aortic dissection business.industry Mortality rate Hazard ratio medicine.disease Intensive care unit Perfusion Aortic Dissection Circulatory Arrest Deep Hypothermia Induced Treatment Outcome Anesthesia Cerebrovascular Circulation Deep hypothermic circulatory arrest Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart, lungcirculation. 30(7) |
| ISSN: | 1444-2892 |
| Popis: | Aim Hypothermia and selective brain perfusion is used for brain protection during an acute type A aortic dissection (ATAAD) correction. We compared the outcomes between antegrade and retrograde cerebral perfusion techniques after ATAAD surgery. Method Between January 1995 and August 2017, 290 patients underwent ATAAD repair under deep hypothermic circulatory arrest/retrograde cerebral perfusion (DHCA/RCP) in 173 patients and moderate hypothermic circulatory arrest/antegrade cerebral perfusion (MHCA/ACP) in 117 patients. Outcomes of interest were: 30-day mortality, new-onset postoperative neurological complications, and length of intensive care unit (ICU) and in-hospital stays. Results No differences were observed between the preoperative details of both groups (p>0.05). Thirty-day (30-day) mortality did not differ between groups (RCP vs ACP, 22% vs 21.4%; p=0.90). New-onset postoperative permanent neurological dysfunctions and coma was similar in two group in 6.9% versus 10.3% of patients and 3.8% versus 6.8% patients of patients, respectively (p=0.69). The incidence of 30-day mortality and new postoperative neurological complications were similar in the RCP and ACP groups (odds ratio [OR], 1.0; 95% confidence interval [CI], 0.39–2.83 [p=0.91] and OR, 1.7; 95% CI, 0.87–3.23 [p=0.11], respectively). There was no difference between length of stay in the ICU and overall stay in hospital between the RCP and ACP groups (p=0.31 and p=0.14, respectively). No difference in survival rate was observed between the RCP and ACP groups (hazard ratio, 1.2; 95% CI, 0.76–2.01 [p=0.39]). Conclusions Thirty-day (30-day) mortality rate, new-onset postoperative neurological dysfunctions, ICU stay, and in-hospital stay did not differ between the MHCA/ACP and DHCA/RCP groups after ATAAD correction. Although the rates of 30-day mortality and postoperative neurological complications were high after ATAAD repair, ACP had no advantages over the RCP technique. |
| Databáze: | OpenAIRE |
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