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    Neuroprotective strategies in acute aortic dissection: an analysis of the UK National Adult Cardiac Surgical Audit

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    Author
    Mariscalco, Giovanni
    Keyword
    antegrade cerebral perfusion
    cerebrovascular accidents
    deep hypothermia
    neuroprotection
    type A aortic dissection
    Date
    2021-12
    
    Metadata
    Show full item record
    Publisher's URL
    https://academic.oup.com/ejcts/article/60/6/1437/6272121?login=false
    Abstract
    Objectives: The risk of brain injury following surgery for type A aortic dissection (TAAD) remains substantial and no consensus has still been reached on which neuroprotective technique should be preferred. We aimed to investigate the association between neuroprotective strategies and clinical outcomes following TAAD repair. Methods: Using the UK National Adult Cardiac Surgical Audit, we identified 1929 patients undergoing surgery for TAAD (2011-2018). Deep hypothermic circulatory arrest (DHCA) only, unilateral (uACP), bilateral antegrade cerebral perfusion (bACP) and retrograde cerebral perfusion were used in 830, 117, 760 and 222 patients, respectively. The primary end point was a composite of death and/or cerebrovascular accident (CVA). Generalized linear mixed model was used to adjust the effect of neuroprotective strategies for other confounders. Results: The use of bACP was associated with longer circulatory arrest (CA) compared to other strategies. There was a trend towards lower incidence of death and/or CVA using uACP only for shorter CA. In particular, primary end point rate was 27.7% overall and 26.5%, 12.5%, 28.0% and 22.9% for CA <30 min and 28.6%, 30.4%, 33.3% and 33.0% for CA ≥30 min with DHCA only, uACP, bACP and retrograde cerebral perfusion, respectively. The use of DHCA only was associated with five-fold [odds ratio (OR) 5.35, 95% confidence interval (CI) 1.36-21.02] and two-fold (OR 1.77, 95% CI 1.01-3.09) increased risk of death and/or CVA compared to uACP and bACP, respectively, but the effect of uACP was significantly associated with CA duration (hazard ratio 0.97, 95% CI 0.94-0.99; P = 0.04). Conclusions: In TAAD repair, the use of uACP and bACP was associated with a lower adjusted risk of death and/or CVA when compared to DHCA. uACP can offer some advantage but only for a shorter CA duration.
    Citation
    Benedetto, U., Dimagli, A., Cooper, G., Uppal, R., Mariscalco, G., Krasopoulos, G., Goodwin, A., Trivedi, U., Kendall, S., Sinha, S., Fudulu, D., Angelini, G. D., Tsang, G., Akowuah, E., & UK Aortic Surgery (2021). Neuroprotective strategies in acute aortic dissection: an analysis of the UK National Adult Cardiac Surgical Audit. European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 60(6), 1437–1444. https://doi.org/10.1093/ejcts/ezab192
    Type
    Article
    URI
    http://hdl.handle.net/20.500.12904/15284
    Collections
    Cardiac Surgery

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