Key result
Antegrade cerebral perfusion outperforms retrograde perfusion or arrest alone during aortic arch surgery, despite weak evidence.
Why the study?
The benefit of antegrade versus retrograde cerebral perfusion as an adjunct to hypothermic circulatory arrest in aortic arch surgery to reduce neurological injury or mortality was uncertain.
Does antegrade cerebral perfusion reduce neurological injury or mortality in patients having aortic arch surgery compared to retrograde cerebral perfusion or hypothermic circulatory arrest alone?
Systematic Review
Does antegrade cerebral perfusion reduce neurological injury or mortality in patients having aortic arch surgery compared to retrograde cerebral perfusion or hypothermic circulatory arrest alone?
Antegrade cerebral perfusion appears superior to retrograde cerebral perfusion or hypothermic circulatory arrest alone for reducing neurological injury or mortality during aortic arch surgery, though high-quality prospective evidence is lacking.
Answers are grounded in this paper and cite their sources.
Antegrade cerebral perfusion may be preferred in aortic arch surgery; leaves open confirmation by high-quality randomized trials.
A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether patients having aortic arch surgery benefit from antegrade or retrograde cerebral perfusion in addition to hypothermic circulatory arrest to reduce neurological injury or mortality. Altogether 408 papers were found using the reported search, of which 16 presented the best evidence to answer the clinical question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that antegrade cerebral perfusion is superior as an adjunct to hypothermic circulatory arrest when compared to retrograde cerebral perfusion or hypothermic circulatory arrest alone, although clinical evidence for this from prospective clinical trials is weak.
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Barnard et al. (2004) conducted a systematic review in aortic arch surgery. Antegrade cerebral perfusion vs. Retrograde cerebral perfusion or hypothermic circulatory arrest alone was evaluated on Neurological injury or mortality. Antegrade cerebral perfusion is superior to retrograde cerebral perfusion or hypothermic circulatory arrest alone as an adjunct during aortic arch surgery, though prospective clinical evidence is weak.
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