Key result
Retrograde cerebral perfusion linked to ~666% higher 30-day mortality vs antegrade perfusion during aortic dissection repair.
Why the study?
Comparative short- and long-term outcomes of retrograde versus antegrade cerebral perfusion during circulatory arrest for acute type A aortic dissection repair remain debated.
Does retrograde cerebral perfusion compared to antegrade cerebral perfusion improve postoperative outcomes in adult patients undergoing emergent repair of acute type A aortic dissection?
Cohort (n=116)
No
Does retrograde cerebral perfusion compared to antegrade cerebral perfusion improve postoperative outcomes in adult patients undergoing emergent repair of acute type A aortic dissection?
Odds Ratio: 7.66 (95% CI 2.16–27.13)
Absolute Event Rate: 40% vs 13%
p-value: p=0.002
In patients undergoing emergent repair of acute type A aortic dissection, retrograde cerebral perfusion is associated with significantly higher 30-day mortality and postoperative complications compared to antegrade cerebral perfusion.
Should not yet change cerebral perfusion strategy; leaves open optimal approach for type A dissection repair.
BackgroundThe comparative short-and long-term outcomes of retrograde versus antegrade cerebral perfusion during circulatory arrest for acute type A aortic dissection repair remain debated. MethodsIn this single-center retrospective study, postoperative outcomes were compared between retrograde and antegrade cerebral perfusion.Retrograde cerebral perfusion was employed in older patients (median age = 72 vs. 63 years; p = 0.030), with comparable body mass index (29 vs. 28 kg/m²; p = 0.649). ResultsRelative to antegrade cerebral perfusion, retrograde cerebral perfusion was associated with increased 30-day mortality (40% vs. 13%; p = 0.003), postoperative pericardial and pleural effusion (75% vs. 43%; p = 0.009), and cerebrovascular accident (35% vs. 16%; p = 0.044).After multivariable adjustment for circulatory arrest time and nadir hypothermic temperature, retrograde perfusion independently predicted 30-day mortality (adjusted odds ratio: 7.66; 95% CI: 2.16-27.13;p = 0.002). ConclusionsThese findings suggest that retrograde cerebral perfusion is associated with worse postoperative outcomes following acute type A aortic dissection repair and warrant further investigation.
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Chakraborty et al. (2026) conducted a cohort in Acute type A aortic dissection (n=116). Retrograde cerebral perfusion vs. Antegrade cerebral perfusion was evaluated on 30-day mortality (OR 7.66, 95% CI 2.16-27.13, p=0.002). Retrograde cerebral perfusion was associated with significantly higher 30-day mortality (adjusted OR 7.66) compared to antegrade cerebral perfusion during emergent acute type A aortic dissection repair.
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