Key result
Antegrade cerebral perfusion during surgery for acute type A aortic dissection was associated with reduced hospital mortality (9%, P=0.05) and protected against late death (P<0.05).
Why the study?
Does antegrade cerebral perfusion improve survival in patients undergoing surgery for acute type A aortic dissection compared to deep hypothermia alone or with retrograde cerebral perfusion?
Cohort (n=105)
No
Does antegrade cerebral perfusion improve survival in patients undergoing surgery for acute type A aortic dissection compared to deep hypothermia alone or with retrograde cerebral perfusion?
Answers are grounded in this paper and cite their sources.
Antegrade cerebral perfusion during surgery for acute type A aortic dissection is associated with reduced hospital mortality and improved long-term survival compared to other brain protection strategies.
Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age >or=70 years and preoperative shock (P<0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (P=0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6+/-1.7%, 84.3+/-4.4%, 60.7+/-7.5% and 57.1+/-7.8%, respectively. The only late death risk predictor was the non-use of ACP (P<0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice.
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Forteza et al. (2009) conducted a cohort in Acute type A aortic dissection (n=105). Antegrade cerebral perfusion (ACP) vs. Non-use of ACP (deep hypothermia alone or with retrograde cerebral perfusion) was evaluated on Hospital mortality (p=0.05). Antegrade cerebral perfusion during surgery for acute type A aortic dissection was associated with reduced hospital mortality (9%, P=0.05) and protected against late death (P<0.05).
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