Bilateral versus unilateral antegrade cerebral perfusion in arch reconstruction for aortic dissection - PubMed
Comparative Study
. 2012 Jun;93(6):1917-20.
doi: 10.1016/j.athoracsur.2012.02.090. Epub 2012 May 3.
Affiliations
- PMID: 22560261
- DOI: 10.1016/j.athoracsur.2012.02.090
Comparative Study
Bilateral versus unilateral antegrade cerebral perfusion in arch reconstruction for aortic dissection
Shuyang Lu et al. Ann Thorac Surg. 2012 Jun.
Abstract
Background: The superiority of bilateral versus unilateral antegrade cerebral perfusion (ACP) has been the subject of much debate. This study aimed to compare the two methods of cerebral perfusion.
Methods: Between September 2005 and June 2011, 263 patients (median age 51.4±10.1 years, range, 26 to 75; 200 men) underwent open aortic arch reconstruction with hypothermic circulatory arrest and bilateral or unilateral ACP. Among them, 231 patients had acute aortic dissection, 12 had subacute aortic dissection, 20 had chronic aortic dissection, 7 had Marfan syndrome, 8 had reconstruction secondary to endovascular stent graft placement for type B dissection, and 9 had bicuspid aortic valve. Our patient cohort is divided into those protected with hypothermic circulatory arrest and bilateral ACP (group A, n=128) and those with hypothermic circulatory arrest and unilateral ACP (group B, n=135).
Results: There was no significant difference between groups A and B in cardiopulmonary bypass time, cross-clamp time, or cerebral perfusion time. Overall in-hospital mortality was 11.7% for group A and 11.1% for group B (p=0.877). Postoperative temporary and permanent neurologic dysfunction was 5.5% versus 6.7% and 12.5% versus 10.4%, respectively (group A versus group B: p=0.685, p=0.587). Intensive care unit time was 9.4±9.8 days for group A and 8.4±14.0 days for group B (p=0.972). Hospitalization was 24.3±14.6 days for group A and 23.1±21.1 days for group B (p=0.172).
Conclusions: Unilateral ACP with hypothermic circulatory arrest is a safe cerebral protection technique for open aortic arch reconstruction, and is not inferior to bilateral ACP with hypothermic circulatory arrest.
Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.
Comment in
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Single cannulation, bilateral brain perfusion.
Bovio E, Mve Mvondo C, Chiariello GA, Bassano C. Bovio E, et al. Ann Thorac Surg. 2013 Mar;95(3):1138-9. doi: 10.1016/j.athoracsur.2012.10.012. Ann Thorac Surg. 2013. PMID: 23438559 No abstract available.
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Lu S, Sun X, Wang C. Lu S, et al. Ann Thorac Surg. 2013 Mar;95(3):1139-40. doi: 10.1016/j.athoracsur.2012.11.040. Ann Thorac Surg. 2013. PMID: 23438560 No abstract available.
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