Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective
Objectives: To compare unilateral versus bilateral antegrade cerebral perfusion (ACP) techniques on cerebral protection during acute type A aortic dissection repair. Methods: Using an institutional database, we retrospectively reviewed patients who underwent acute type A aortic dissection repair wit...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-09-01
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| Series: | JTCVS Open |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666273622002273 |
| _version_ | 1811209054879481856 |
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| author | Seung Jun Song, MD, PhD Wan Kee Kim, MD Tae-Hoon Kim, MD Suk-Won Song, MD, PhD |
| author_facet | Seung Jun Song, MD, PhD Wan Kee Kim, MD Tae-Hoon Kim, MD Suk-Won Song, MD, PhD |
| author_sort | Seung Jun Song, MD, PhD |
| collection | DOAJ |
| description | Objectives: To compare unilateral versus bilateral antegrade cerebral perfusion (ACP) techniques on cerebral protection during acute type A aortic dissection repair. Methods: Using an institutional database, we retrospectively reviewed patients who underwent acute type A aortic dissection repair with selective ACP techniques from October 2008 to December 2019. Primary end point was the detection of neurologic dysfunctions. The secondary end point was mortality. For baseline adjustment, the propensity score matching method was used. Multivariable logistic regression analysis was performed to determine the predictor of neurologic events. Results: Among 522 patients (aged 62.0 ± 14.9 years; 45.7% women), unilateral and bilateral ACP techniques were used in 357 (64.7%) and 165 (35.3%) patients, respectively. Transient (19.6% vs 21.2%; P = .65) and permanent (7.0% vs 10.3%; P = .70) neurologic dysfunction rates were not significantly different in patients with unilateral versus bilateral ACP, respectively. Observed mortality rate was higher in the patients with bilateral ACP (hazard ratio, 2.05; 95% CI, 1.33-3.14; P = .001). Propensity-score matching yielded 94 pairs of patients. In matched analysis, bilateral ACP did not significantly lower the risks for transient (odds ratio, 0.87; 95% CI, 0.42-1.81; P = .71) and permanent (odds ratio, 1.42; 95% CI, 0.55-3.85; P = .47) neurologic dysfunction or death (hazard ratio, 1.65; 95% CI, 0.87-3.15; P = .13). In the multivariable analysis, the ACP technique was not significantly associated with perioperative neurologic deficit. Conclusions: Despite additional supply, the patients undergoing bilateral ACP during acute type A aortic dissection repair did not have superior outcomes in neurologic and death events compared with the patients undergoing unilateral ACP. |
| first_indexed | 2024-04-12T04:31:48Z |
| format | Article |
| id | doaj.art-dbccdf1d734540b1994f0774de58cb37 |
| institution | Directory Open Access Journal |
| issn | 2666-2736 |
| language | English |
| last_indexed | 2024-04-12T04:31:48Z |
| publishDate | 2022-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JTCVS Open |
| spelling | doaj.art-dbccdf1d734540b1994f0774de58cb372022-12-22T03:47:55ZengElsevierJTCVS Open2666-27362022-09-01113748Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspectiveSeung Jun Song, MD, PhD0Wan Kee Kim, MD1Tae-Hoon Kim, MD2Suk-Won Song, MD, PhD3Department of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South KoreaDepartment of Thoracic and Cardiovascular Surgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South KoreaDepartment of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South KoreaDepartment of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Gangnam-gu, Seoul, South Korea; Address for reprints: Suk-Won Song, MD, PhD, Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine, 211 Enoju-ro, Gangnam-gu, Seoul 06273, Republic of Korea.Objectives: To compare unilateral versus bilateral antegrade cerebral perfusion (ACP) techniques on cerebral protection during acute type A aortic dissection repair. Methods: Using an institutional database, we retrospectively reviewed patients who underwent acute type A aortic dissection repair with selective ACP techniques from October 2008 to December 2019. Primary end point was the detection of neurologic dysfunctions. The secondary end point was mortality. For baseline adjustment, the propensity score matching method was used. Multivariable logistic regression analysis was performed to determine the predictor of neurologic events. Results: Among 522 patients (aged 62.0 ± 14.9 years; 45.7% women), unilateral and bilateral ACP techniques were used in 357 (64.7%) and 165 (35.3%) patients, respectively. Transient (19.6% vs 21.2%; P = .65) and permanent (7.0% vs 10.3%; P = .70) neurologic dysfunction rates were not significantly different in patients with unilateral versus bilateral ACP, respectively. Observed mortality rate was higher in the patients with bilateral ACP (hazard ratio, 2.05; 95% CI, 1.33-3.14; P = .001). Propensity-score matching yielded 94 pairs of patients. In matched analysis, bilateral ACP did not significantly lower the risks for transient (odds ratio, 0.87; 95% CI, 0.42-1.81; P = .71) and permanent (odds ratio, 1.42; 95% CI, 0.55-3.85; P = .47) neurologic dysfunction or death (hazard ratio, 1.65; 95% CI, 0.87-3.15; P = .13). In the multivariable analysis, the ACP technique was not significantly associated with perioperative neurologic deficit. Conclusions: Despite additional supply, the patients undergoing bilateral ACP during acute type A aortic dissection repair did not have superior outcomes in neurologic and death events compared with the patients undergoing unilateral ACP.http://www.sciencedirect.com/science/article/pii/S2666273622002273aortic dissectionselective cerebral perfusioncerebral protection |
| spellingShingle | Seung Jun Song, MD, PhD Wan Kee Kim, MD Tae-Hoon Kim, MD Suk-Won Song, MD, PhD Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective JTCVS Open aortic dissection selective cerebral perfusion cerebral protection |
| title | Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective |
| title_full | Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective |
| title_fullStr | Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective |
| title_full_unstemmed | Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective |
| title_short | Unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type A aortic dissectionCentral MessagePerspective |
| title_sort | unilateral versus bilateral antegrade cerebral perfusion during surgical repair for patients with acute type a aortic dissectioncentral messageperspective |
| topic | aortic dissection selective cerebral perfusion cerebral protection |
| url | http://www.sciencedirect.com/science/article/pii/S2666273622002273 |
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