Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest
Ede, Jacob LU
; Teurneau-Hermansson, Karl
LU
; Ramgren, Birgitta
LU
; Moseby-Knappe, Marion
LU
; Åström, Daniel Oudin
LU
; Larsson, Mårten
LU
; Sjögren, Johan
LU
; Wierup, Per
LU
; Nozohoor, Shahab
LU
and Zindovic, Igor
LU
(2024)
In Journal of Cardiothoracic Surgery
19(1).
- Abstract
Background: To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection. Methods: Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was... (More)
Background: To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection. Methods: Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was performed to identify independent predictors of the primary outcomes. Survival analysis was performed using Kaplan-Meier estimates. Results: Clinical neurological injury and embolic lesions were less frequent in patients with retrograde cerebral perfusion (20.2% vs. 28.4%, p = 0.041 and 13.7% vs. 23.4%, p = 0.010, respectively), but there was no significant difference in the occurrence of watershed lesions (3.0% vs. 6.1%, p = 0.156). However, after multivariable logistic regression, retrograde cerebral perfusion was associated with a significant reduction of clinical neurological injury (OR: 0.60; 95% CI 0.36–0.995, p = 0.049), embolic lesions (OR: 0.55; 95% CI 0.31–0.97, p = 0.041), and watershed lesions (OR: 0.25; 95%CI 0.07–0.80, p = 0.027). There was no significant difference in 30-day mortality (12.8% vs. 11.7%, p = ns) or long-term survival between groups. Conclusion: In this study, we showed that the addition of retrograde cerebral perfusion during hypothermic circulatory arrest in the setting of acute type A aortic dissection repair reduced the risk of clinical neurological injury, embolic lesions, and watershed lesions.
(Less)
- author
- Ede, Jacob
LU
; Teurneau-Hermansson, Karl
LU
; Ramgren, Birgitta
LU
; Moseby-Knappe, Marion
LU
; Åström, Daniel Oudin
LU
; Larsson, Mårten
LU
; Sjögren, Johan
LU
; Wierup, Per
LU
; Nozohoor, Shahab
LU
and Zindovic, Igor
LU
- organization
-
- Thoracic Surgery
- Neurological injury in acute type A aortic dissection (research group)
- Diagnostic Radiology, (Lund)
- Neuroradiology (research group)
- Neurology, Lund
- Brain Injury After Cardiac Arrest (research group)
- Planetary Health (research group)
- Bleeding disorders and acute typ-A dissection (research group)
- Minimal invasive cardiac surgery in valvular heart disease (research group)
- Heparin bindning protein in cardiothoracic surgery (research group)
- publishing date
- 2024-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Aorta, Dissection, Embolism, Retrograde cerebral perfusion, Stroke, Watershed lesions
- in
- Journal of Cardiothoracic Surgery
- volume
- 19
- issue
- 1
- article number
- 302
- publisher
- BioMed Central (BMC)
- external identifiers
-
- scopus:85194770309
- pmid:38811972
- ISSN
- 1749-8090
- DOI
- 10.1186/s13019-024-02814-8
- language
- English
- LU publication?
- yes
- id
- b7177bd7-8615-4463-bc4a-972457b468ad
- date added to LUP
- 2024-08-23 16:09:13
- date last changed
- 2024-08-24 03:00:06
@article{b7177bd7-8615-4463-bc4a-972457b468ad,
abstract = {{<p>Background: To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection. Methods: Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion. The primary endpoints were clinical neurological injury, embolic lesions, and watershed lesions. Multivariable logistic regression was performed to identify independent predictors of the primary outcomes. Survival analysis was performed using Kaplan-Meier estimates. Results: Clinical neurological injury and embolic lesions were less frequent in patients with retrograde cerebral perfusion (20.2% vs. 28.4%, p = 0.041 and 13.7% vs. 23.4%, p = 0.010, respectively), but there was no significant difference in the occurrence of watershed lesions (3.0% vs. 6.1%, p = 0.156). However, after multivariable logistic regression, retrograde cerebral perfusion was associated with a significant reduction of clinical neurological injury (OR: 0.60; 95% CI 0.36–0.995, p = 0.049), embolic lesions (OR: 0.55; 95% CI 0.31–0.97, p = 0.041), and watershed lesions (OR: 0.25; 95%CI 0.07–0.80, p = 0.027). There was no significant difference in 30-day mortality (12.8% vs. 11.7%, p = ns) or long-term survival between groups. Conclusion: In this study, we showed that the addition of retrograde cerebral perfusion during hypothermic circulatory arrest in the setting of acute type A aortic dissection repair reduced the risk of clinical neurological injury, embolic lesions, and watershed lesions.</p>}},
author = {{Ede, Jacob and Teurneau-Hermansson, Karl and Ramgren, Birgitta and Moseby-Knappe, Marion and Åström, Daniel Oudin and Larsson, Mårten and Sjögren, Johan and Wierup, Per and Nozohoor, Shahab and Zindovic, Igor}},
issn = {{1749-8090}},
keywords = {{Aorta; Dissection; Embolism; Retrograde cerebral perfusion; Stroke; Watershed lesions}},
language = {{eng}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{Journal of Cardiothoracic Surgery}},
title = {{Retrograde cerebral perfusion reduces embolic and watershed lesions after acute type a aortic dissection repair with deep hypothermic circulatory arrest}},
url = {{http://dx.doi.org/10.1186/s13019-024-02814-8}},
doi = {{10.1186/s13019-024-02814-8}},
volume = {{19}},
year = {{2024}},
}