Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study
Abstract OBJECTIVES The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection. METHODS Data from 646 patients who underw...
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| Veröffentlicht in: | European journal of cardio-thoracic surgery 2022-03, Vol.61 (4), p.828-835 |
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| creator | Piperata, Antonio Watanabe, Masazumi Pernot, Mathieu Metras, Alexandre Kalscheuer, Gregory Avesani, Martina Barandon, Laurent Peltan, Julien Lorenzoni, Giulia Jorgji, Vjola Gregori, Dario Takahashi, Shinya Labrousse, Louis Gerosa, Gino Bottio, Tomaso |
| description | Abstract
OBJECTIVES
The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection.
METHODS
Data from 646 patients who underwent surgical repair of thoracic type A aortic dissection using unilateral and bilateral ACP with moderate hypothermic circulatory arrest in 3 cardiac surgical institutions between 2008 and 2018 were analysed. Propensity matching was performed to assess which technique ensured better outcomes.
RESULTS
Unilateral and bilateral ACP techniques were performed in 250 (39%) and in 396 (61%) patients, respectively. Propensity score analysis identified 189 matched pairs. In the matched cohort, the lowest core temperature was 27.5°C and 28°C in the bilateral and unilateral groups, respectively (P |
| doi_str_mv | 10.1093/ejcts/ezab341 |
| format | Article |
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OBJECTIVES
The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection.
METHODS
Data from 646 patients who underwent surgical repair of thoracic type A aortic dissection using unilateral and bilateral ACP with moderate hypothermic circulatory arrest in 3 cardiac surgical institutions between 2008 and 2018 were analysed. Propensity matching was performed to assess which technique ensured better outcomes.
RESULTS
Unilateral and bilateral ACP techniques were performed in 250 (39%) and in 396 (61%) patients, respectively. Propensity score analysis identified 189 matched pairs. In the matched cohort, the lowest core temperature was 27.5°C and 28°C in the bilateral and unilateral groups, respectively (P < 0.001). The unilateral technique required significantly shorter aortic cross-clamp and cardiopulmonary bypass times than bilateral technique [82 min vs 100 min (P < 0.001); 170 min vs 195 min (P < 0.001)]. The 30-day mortality was comparable (P = 0.325). The bilateral group reported a significantly higher incidence of permanent neurologic deficits (P < 0.001), left brain hemisphere stroke (P = 0.007) and all-combined complications (P < 0.001). Ten-year survival was comparable (P = 0.45).
CONCLUSIONS
Unilateral and bilateral ACP are both valid brain protection strategies in the landscape of aortic arch surgery. While admitting all the study limitations, unilateral technique could offer some clinical advantages.
Clinical registration number
76049
The surgical treatment of acute type A aortic dissection (ATAAD) remains one of the biggest technical challenges in cardiac surgery.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezab341</identifier><identifier>PMID: 34302165</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><subject>Aneurysm, Dissecting - surgery ; Aorta, Thoracic - surgery ; Cerebrovascular Circulation ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Perfusion - methods ; Retrospective Studies ; Treatment Outcome</subject><ispartof>European journal of cardio-thoracic surgery, 2022-03, Vol.61 (4), p.828-835</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c295t-d05d9ddd08e8c89b9cf9f6e9e397fc8d6d4fb58ea1669a23091eeb9bfd90d5243</citedby><cites>FETCH-LOGICAL-c295t-d05d9ddd08e8c89b9cf9f6e9e397fc8d6d4fb58ea1669a23091eeb9bfd90d5243</cites><orcidid>0000-0001-9128-9740 ; 0000-0002-6261-699X ; 0000-0001-5882-8925 ; 0000-0001-7299-2983 ; 0000-0003-4970-4562 ; 0000-0002-5339-6534</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34302165$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Piperata, Antonio</creatorcontrib><creatorcontrib>Watanabe, Masazumi</creatorcontrib><creatorcontrib>Pernot, Mathieu</creatorcontrib><creatorcontrib>Metras, Alexandre</creatorcontrib><creatorcontrib>Kalscheuer, Gregory</creatorcontrib><creatorcontrib>Avesani, Martina</creatorcontrib><creatorcontrib>Barandon, Laurent</creatorcontrib><creatorcontrib>Peltan, Julien</creatorcontrib><creatorcontrib>Lorenzoni, Giulia</creatorcontrib><creatorcontrib>Jorgji, Vjola</creatorcontrib><creatorcontrib>Gregori, Dario</creatorcontrib><creatorcontrib>Takahashi, Shinya</creatorcontrib><creatorcontrib>Labrousse, Louis</creatorcontrib><creatorcontrib>Gerosa, Gino</creatorcontrib><creatorcontrib>Bottio, Tomaso</creatorcontrib><title>Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Abstract
OBJECTIVES
The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection.
METHODS
Data from 646 patients who underwent surgical repair of thoracic type A aortic dissection using unilateral and bilateral ACP with moderate hypothermic circulatory arrest in 3 cardiac surgical institutions between 2008 and 2018 were analysed. Propensity matching was performed to assess which technique ensured better outcomes.
RESULTS
Unilateral and bilateral ACP techniques were performed in 250 (39%) and in 396 (61%) patients, respectively. Propensity score analysis identified 189 matched pairs. In the matched cohort, the lowest core temperature was 27.5°C and 28°C in the bilateral and unilateral groups, respectively (P < 0.001). The unilateral technique required significantly shorter aortic cross-clamp and cardiopulmonary bypass times than bilateral technique [82 min vs 100 min (P < 0.001); 170 min vs 195 min (P < 0.001)]. The 30-day mortality was comparable (P = 0.325). The bilateral group reported a significantly higher incidence of permanent neurologic deficits (P < 0.001), left brain hemisphere stroke (P = 0.007) and all-combined complications (P < 0.001). Ten-year survival was comparable (P = 0.45).
CONCLUSIONS
Unilateral and bilateral ACP are both valid brain protection strategies in the landscape of aortic arch surgery. While admitting all the study limitations, unilateral technique could offer some clinical advantages.
Clinical registration number
76049
The surgical treatment of acute type A aortic dissection (ATAAD) remains one of the biggest technical challenges in cardiac surgery.</description><subject>Aneurysm, Dissecting - surgery</subject><subject>Aorta, Thoracic - surgery</subject><subject>Cerebrovascular Circulation</subject><subject>Circulatory Arrest, Deep Hypothermia Induced</subject><subject>Humans</subject><subject>Perfusion - methods</subject><subject>Retrospective Studies</subject><subject>Treatment Outcome</subject><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkEtLw0AUhQdRbK0u3cos3cTOZPIad6X4goIbC-7CPO6UlDSJ8xAi_nhT-3Dp6h7O_e65cBC6puSOEs6msFbeTeFLSJbQEzSmRc6inCXvp4MmlEQ5T8gIXTi3JoRkLM7P0YgljMQ0S8foe9lUtfBgRY0_wbrgsDwaCizIrejAmuCqtsE62KpZYdFaXynsgl2B7bFpLRYqeMC-7wDPDntdOQfKD4f3WOBNqAcTGm8BOx90f4nOjKgdXO3nBC0fH97mz9Hi9ellPltEKuapjzRJNddakwIKVXDJleEmAw6M50YVOtOJkWkBgmYZFzEjnAJILo3mRKdxwibodpfb2fYjgPPlpnIK6lo00AZXxmmaUkoTVgxotEOVbZ2zYMrOVhth-5KSclt4-Vt4uS984G_20UFuQB_pQ8N_v9vQ_ZP1A90Dj-Y</recordid><startdate>20220324</startdate><enddate>20220324</enddate><creator>Piperata, Antonio</creator><creator>Watanabe, Masazumi</creator><creator>Pernot, Mathieu</creator><creator>Metras, Alexandre</creator><creator>Kalscheuer, Gregory</creator><creator>Avesani, Martina</creator><creator>Barandon, Laurent</creator><creator>Peltan, Julien</creator><creator>Lorenzoni, Giulia</creator><creator>Jorgji, Vjola</creator><creator>Gregori, Dario</creator><creator>Takahashi, Shinya</creator><creator>Labrousse, Louis</creator><creator>Gerosa, Gino</creator><creator>Bottio, Tomaso</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0001-9128-9740</orcidid><orcidid>https://orcid.org/0000-0002-6261-699X</orcidid><orcidid>https://orcid.org/0000-0001-5882-8925</orcidid><orcidid>https://orcid.org/0000-0001-7299-2983</orcidid><orcidid>https://orcid.org/0000-0003-4970-4562</orcidid><orcidid>https://orcid.org/0000-0002-5339-6534</orcidid></search><sort><creationdate>20220324</creationdate><title>Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study</title><author>Piperata, Antonio ; Watanabe, Masazumi ; Pernot, Mathieu ; Metras, Alexandre ; Kalscheuer, Gregory ; Avesani, Martina ; Barandon, Laurent ; Peltan, Julien ; Lorenzoni, Giulia ; Jorgji, Vjola ; Gregori, Dario ; Takahashi, Shinya ; Labrousse, Louis ; Gerosa, Gino ; Bottio, Tomaso</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c295t-d05d9ddd08e8c89b9cf9f6e9e397fc8d6d4fb58ea1669a23091eeb9bfd90d5243</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Aneurysm, Dissecting - surgery</topic><topic>Aorta, Thoracic - surgery</topic><topic>Cerebrovascular Circulation</topic><topic>Circulatory Arrest, Deep Hypothermia Induced</topic><topic>Humans</topic><topic>Perfusion - methods</topic><topic>Retrospective Studies</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Piperata, Antonio</creatorcontrib><creatorcontrib>Watanabe, Masazumi</creatorcontrib><creatorcontrib>Pernot, Mathieu</creatorcontrib><creatorcontrib>Metras, Alexandre</creatorcontrib><creatorcontrib>Kalscheuer, Gregory</creatorcontrib><creatorcontrib>Avesani, Martina</creatorcontrib><creatorcontrib>Barandon, Laurent</creatorcontrib><creatorcontrib>Peltan, Julien</creatorcontrib><creatorcontrib>Lorenzoni, Giulia</creatorcontrib><creatorcontrib>Jorgji, Vjola</creatorcontrib><creatorcontrib>Gregori, Dario</creatorcontrib><creatorcontrib>Takahashi, Shinya</creatorcontrib><creatorcontrib>Labrousse, Louis</creatorcontrib><creatorcontrib>Gerosa, Gino</creatorcontrib><creatorcontrib>Bottio, Tomaso</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Piperata, Antonio</au><au>Watanabe, Masazumi</au><au>Pernot, Mathieu</au><au>Metras, Alexandre</au><au>Kalscheuer, Gregory</au><au>Avesani, Martina</au><au>Barandon, Laurent</au><au>Peltan, Julien</au><au>Lorenzoni, Giulia</au><au>Jorgji, Vjola</au><au>Gregori, Dario</au><au>Takahashi, Shinya</au><au>Labrousse, Louis</au><au>Gerosa, Gino</au><au>Bottio, Tomaso</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2022-03-24</date><risdate>2022</risdate><volume>61</volume><issue>4</issue><spage>828</spage><epage>835</epage><pages>828-835</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Abstract
OBJECTIVES
The aim of this retrospective multicentre study was to investigate and compare clinical outcomes of unilateral and bilateral antegrade cerebral perfusion (ACP) strategies on cerebral protection during surgery for type A aortic dissection.
METHODS
Data from 646 patients who underwent surgical repair of thoracic type A aortic dissection using unilateral and bilateral ACP with moderate hypothermic circulatory arrest in 3 cardiac surgical institutions between 2008 and 2018 were analysed. Propensity matching was performed to assess which technique ensured better outcomes.
RESULTS
Unilateral and bilateral ACP techniques were performed in 250 (39%) and in 396 (61%) patients, respectively. Propensity score analysis identified 189 matched pairs. In the matched cohort, the lowest core temperature was 27.5°C and 28°C in the bilateral and unilateral groups, respectively (P < 0.001). The unilateral technique required significantly shorter aortic cross-clamp and cardiopulmonary bypass times than bilateral technique [82 min vs 100 min (P < 0.001); 170 min vs 195 min (P < 0.001)]. The 30-day mortality was comparable (P = 0.325). The bilateral group reported a significantly higher incidence of permanent neurologic deficits (P < 0.001), left brain hemisphere stroke (P = 0.007) and all-combined complications (P < 0.001). Ten-year survival was comparable (P = 0.45).
CONCLUSIONS
Unilateral and bilateral ACP are both valid brain protection strategies in the landscape of aortic arch surgery. While admitting all the study limitations, unilateral technique could offer some clinical advantages.
Clinical registration number
76049
The surgical treatment of acute type A aortic dissection (ATAAD) remains one of the biggest technical challenges in cardiac surgery.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>34302165</pmid><doi>10.1093/ejcts/ezab341</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-9128-9740</orcidid><orcidid>https://orcid.org/0000-0002-6261-699X</orcidid><orcidid>https://orcid.org/0000-0001-5882-8925</orcidid><orcidid>https://orcid.org/0000-0001-7299-2983</orcidid><orcidid>https://orcid.org/0000-0003-4970-4562</orcidid><orcidid>https://orcid.org/0000-0002-5339-6534</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| language | eng |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Aneurysm, Dissecting - surgery Aorta, Thoracic - surgery Cerebrovascular Circulation Circulatory Arrest, Deep Hypothermia Induced Humans Perfusion - methods Retrospective Studies Treatment Outcome |
| title | Unilateral versus bilateral cerebral perfusion during aortic surgery for acute type A aortic dissection: a multicentre study |
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