Display options
Cite
Stamou SC, Rausch LA, Kouchoukos NT, et al. Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection. Ann Cardiothorac Surg. 2016;5(4):328-35doi: 10.21037/acs.2016.04.02.
Stamou, S. C., Rausch, L. A., Kouchoukos, N. T., Lobdell, K. W., Khabbaz, K., Murphy, E., & Hagberg, R. C. (2016). Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection. Annals of cardiothoracic surgery, 5(4), 328-35. https://doi.org/10.21037/acs.2016.04.02
Stamou, Sotiris C, et al. "Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection." Annals of cardiothoracic surgery vol. 5,4 (2016): 328-35. doi: https://doi.org/10.21037/acs.2016.04.02
Stamou SC, Rausch LA, Kouchoukos NT, Lobdell KW, Khabbaz K, Murphy E, Hagberg RC. Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection. Ann Cardiothorac Surg. 2016 Jul;5(4):328-35. doi: 10.21037/acs.2016.04.02. PMID: 27563545; PMCID: PMC4973129.
Copy Download .nbib Format: NLM
Share it on

Ann Cardiothorac Surg. 2016 Jul;5(4):328-35. doi: 10.21037/acs.2016.04.02.

Comparison between antegrade and retrograde cerebral perfusion or profound hypothermia as brain protection strategies during repair of type A aortic dissection.

Annals of cardiothoracic surgery

Sotiris C Stamou, Laura A Rausch, Nicholas T Kouchoukos, Kevin W Lobdell, Kamal Khabbaz, Edward Murphy, Robert C Hagberg

Affiliations

  1. Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA ;
  2. Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, MO, USA ;
  3. Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, NC, USA ;
  4. Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA ;
  5. Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, MI, USA ;
  6. Department of Cardiac Surgery, Hartford Hospital, Hartford, CT, USA.

PMID: 27563545 PMCID: PMC4973129 DOI: 10.21037/acs.2016.04.02

Abstract

BACKGROUND: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection by the method of cerebral perfusion used.

METHODS: A total of 324 patients from five academic medical centers underwent repair of acute type A aortic dissection between January 2000 and December 2010. Of those, antegrade cerebral perfusion (ACP) was used for 84 patients, retrograde cerebral perfusion (RCP) was used for 55 patients, and deep hypothermic circulatory arrest (DHCA) was used for 184 patients during repair. Major morbidity, operative mortality, and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality and Cox Regression hazard ratios were calculated to determine the predictors of long term mortality.

RESULTS: Operative mortality was not influenced by the type of cerebral protection (19% for ACP, 14.5% for RCP and 19.1% for DHCA, P=0.729). In multivariable logistic regression analysis, hemodynamic instability [odds ratio (OR) =19.6, 95% confidence intervals (CI), 0.102-0.414, P<0.001] and CPB time >200 min(OR =4.7, 95% CI, 1.962-1.072, P=0.029) emerged as independent predictors of operative mortality. Actuarial 5-year survival was unchanged by cerebral protection modality (48.8% for ACP, 61.8% for RCP and 66.8% for no cerebral protection, log-rank P=0.844).

CONCLUSIONS: During surgical repair of type A aortic dissection, ACP, RCP or DHCA are safe strategies for cerebral protection in selected patients with type A aortic dissection.

Keywords: Aorta; aortic dissection; cerebral protection

References

  1. Ann Thorac Surg. 2002 Nov;74(5):S1848-52; discussion S1857-63 - PubMed
  2. Cardiol Clin. 2010 May;28(2):389-401 - PubMed
  3. J Thorac Cardiovasc Surg. 1993 Jul;106(1):19-28; discussion 28-31 - PubMed
  4. Thorac Cardiovasc Surg. 2001 Oct;49(5):283-6 - PubMed
  5. Ann Thorac Surg. 2012 May;93(5):1502-8 - PubMed
  6. Ann Surg. 2001 Sep;234(3):336-42; discussion 342-3 - PubMed
  7. J Thorac Cardiovasc Surg. 2009 Nov;138(5):1081-9 - PubMed
  8. Ann Surg. 1991 Jul;214(1):31-41 - PubMed
  9. Ann Thorac Surg. 2001 Jul;72 (1):72-9 - PubMed
  10. Eur J Cardiothorac Surg. 2014 Aug;46(2):156-66 - PubMed
  11. Circulation. 2011 Jul 26;124(4):434-43 - PubMed
  12. Circulation. 1990 Nov;82(5 Suppl):IV24-38 - PubMed
  13. J Cardiothorac Vasc Anesth. 2006 Feb;20(1):3-7 - PubMed
  14. Ann Thorac Surg. 2001 Jun;71(6):1905-12 - PubMed
  15. Ann Thorac Surg. 2008 May;85(5):1614-8; discussion 1618 - PubMed
  16. Eur J Cardiothorac Surg. 1999 May;15(5):571-8 - PubMed
  17. J Thorac Cardiovasc Surg. 1998 Jan;115(1):129-38 - PubMed
  18. Circulation. 1985 Sep;72(3 Pt 2):II22-34 - PubMed
  19. Semin Thorac Cardiovasc Surg. 1997 Jul;9(3):222-32 - PubMed
  20. J Thorac Cardiovasc Surg. 2008 Sep;136(3):641-8; discussion 948-9 - PubMed
  21. Circulation. 2006 Jul 4;114(1 Suppl):I350-6 - PubMed
  22. Gen Thorac Cardiovasc Surg. 2012 Mar;60(3):132-9 - PubMed
  23. J Thorac Cardiovasc Surg. 2013 Sep;146(3):647-55.e1 - PubMed
  24. Cardiol Clin. 2010 May;28(2):371-9 - PubMed

Publication Types

Grant support