Key result
Antegrade cerebral perfusion during DHCA reduced temporary neurologic dysfunction compared to retrograde perfusion (RR 0.722; 95% CI 0.579-0.900; P=0.004), with similar rates of PND and mortality.
Why the study?
Does antegrade cerebral perfusion reduce neurologic dysfunction and early mortality compared to retrograde cerebral perfusion in patients undergoing aortic surgery during deep hypothermic circulatory arrest?
Meta-Analysis (n=7,023)
Does antegrade cerebral perfusion reduce neurologic dysfunction and early mortality compared to retrograde cerebral perfusion in patients undergoing aortic surgery during deep hypothermic circulatory arrest?
Relative Risk: 0.722 (95% CI 0.579–0.9)
p-value: p=0.004
Antegrade cerebral perfusion during deep hypothermic circulatory arrest for aortic surgery reduces temporary neurologic dysfunction compared to retrograde perfusion, but does not significantly affect permanent neurologic dysfunction, stroke, or early mortality.
Supports preferring antegrade over retrograde cerebral perfusion during DHCA to reduce temporary neurologic dysfunction; confirms meta-analytic benefit without impacting permanent deficits or mortality.
In aortic arch surgery, deep hypothermic circulatory arrest (DHCA) combined with cerebral perfusion is employed worldwide as a routine practice. Even though antegrade cerebral perfusion (ACP) is more widely used than retrograde cerebral perfusion (RCP), the difference in benefit and risk between ACP and RCP during DHCA is uncertain. The purpose of this meta-analysis is to compare neurologic outcomes and early mortality between ACP and RCP in patients who underwent aortic surgery during DHCA. PubMed, EMBASE, and the Cochrane Library were searched using the key words "antegrade," "retrograde," "cerebral perfusion," "cardiopulmonary bypass," "extracorporeal circulation," and "cardiac surgery" for studies reporting on clinical endpoints including early mortality, stroke, temporary neurologic dysfunction (TND), and permanent neurologic dysfunction (PND) in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was analyzed with the Cochrane Q statistic and I(2) statistic. Publication bias was tested with Begg's funnel plot and Egger's test. Thirty-four studies were included in this meta-analysis, with 4262 patients undergoing DHCA + ACP and 2761 undergoing DHCA + RCP. The overall pooled relative risk for TND was 0.722 (95% CI = [0.579, 0.900]), and the z-score for overall effect was 2.9 (P = 0.004). There was low heterogeneity (I(2) = 18.7%). The analysis showed that patients undergoing DHCA + ACP had better outcomes than those undergoing DHCA + RCP in terms of TND, while there were no significant differences between groups in terms of PND, stroke, and early mortality. This meta-analysis indicates that DHCA + ACP has an advantage over DHCA + RCP in terms of TND, while the two methods show similar results in terms of PND, early mortality, and stroke.
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Guo et al. (2015) conducted a meta-analysis in Aortic surgery requiring deep hypothermic circulatory arrest (n=7,023). Antegrade cerebral perfusion (ACP) vs. Retrograde cerebral perfusion (RCP) was evaluated on Temporary neurologic dysfunction (TND) (RR 0.722, 95% CI 0.579-0.900, p=0.004). Antegrade cerebral perfusion during DHCA reduced temporary neurologic dysfunction compared to retrograde perfusion (RR 0.722; 95% CI 0.579-0.900; P=0.004), with similar rates of PND and mortality.
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