Key result
The arch-first technique significantly reduced the mean duration of retrograde cerebral perfusion compared to conventional reconstruction (41.7 vs 63.9 min).
Why the study?
Does the arch-first technique reduce the duration of cerebral ischemia and neurologic dysfunction compared to conventional aortic arch reconstruction in patients undergoing aortic arch operations?
RCT (n=19)
Does the arch-first technique reduce the duration of cerebral ischemia and neurologic dysfunction compared to conventional aortic arch reconstruction in patients undergoing aortic arch operations?
Absolute Event Rate: 41.7% vs 63.9%
The arch-first technique significantly reduces the duration of retrograde cerebral perfusion during aortic arch operations compared to conventional reconstruction, potentially lowering the risk of neurologic dysfunction.
May reduce neurologic risk via shorter cerebral ischemia in arch surgery; extends RCT evidence supporting arch-first reconstruction.
To compare the arch-first technique with conventional aortic arch reconstruction 19 patients were randomly assigned to either procedure. Nine patients underwent the arch-first technique (group A) and 10 underwent the conventional technique (group B). There were no hospital deaths and no significant differences between groups in terms of intraoperative bleeding or the duration of operation cardiopulmonary bypass aortic crossclamping recovery from anesthesia or intensive care. The mean duration of retrograde cerebral perfusion via the superior vena cava was significantly shorter in group A (41.7 +/- 10.4 min) than group B (63.9 +/- 10 min). Transient neurologic dysfunction was noted in 4 (44%) patients in group A 6 (60%) in group B postoperatively but there was no permanent neurologic dysfunction in either group. The arch-first technique makes it possible to reduce the duration of cerebral ischemia retrograde cerebral perfusion via the superior vena cava reestablish antegrade cerebral perfusion earlier without damaging severely atheromatous arch vessels or conducting retrograde cerebral perfusion via a femoral artery. This technique has the potential to reduce the incidence of neurologic dysfunction.
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Tsukui et al. (2002) conducted an RCT in Aortic arch operation (n=19). Arch-first technique vs. Conventional aortic arch reconstruction was evaluated on Mean duration of retrograde cerebral perfusion via the superior vena cava (minutes). The arch-first technique significantly reduced the mean duration of retrograde cerebral perfusion compared to conventional reconstruction (41.7 vs 63.9 min).
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