Clinical Application of Three Antegrade Cerebral Perfusion Strategies in Acute DeBakey Type I Aortic Dissection

Objective: This study aimed to compare the efficacy of three antegrade cerebral perfusion (ACP) strategies in the surgical management of acute DeBakey type I aortic dissection. Methods: This retrospective comparative study included 207 patients with DeBakey type I aortic dissection who underwent surgical treatment at the Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Hengyang Medical School, University of South China, between January 2020 and December 2024. Based on the ACP strategies utilized during surgery and the time periods of implementation, patients were divided into three groups: the unilateral antegrade cerebral perfusion (uACP) group (n = 28), the bilateral antegrade cerebral perfusion (bACP) group (n = 87), and the total antegrade cerebral perfusion (tACP) group (n = 92). Preoperative, intraoperative, and postoperative data were collected and analyzed to identify differences among the three groups. Results: There were no statistically significant differences in baseline clinical characteristics among the three groups, indicating good comparability. The tACP group demonstrated significantly shorter cardiopulmonary bypass times, postoperative awakening times, durations of tracheal intubation, and intensive care unit (ICU) stays compared to the other two groups (p < 0.05). Additionally, the tACP group exhibited a higher minimum nasopharyngeal temperature (approximately 24.8 °C, p < 0.05). The incidence of transient neurological dysfunction (TND) was highest in the uACP group (37.5%), intermediate in the bACP group (18.2%), and lowest in the tACP group (10.6%, p < 0.05). While the bACP group showed an advantage in lower body circulatory arrest time (approximately 28 minutes), the tACP group, despite requiring more meticulous cannulation techniques, provided superior overall neuroprotection. No statistically significant differences were observed among the three groups regarding other postoperative complications (p > 0.05). Conclusion: The tACP strategy demonstrated superior applicability during complex aortic arch reconstruction surgeries, significantly reducing the incidence of TND and accelerating postoperative recovery.