Neuroprotective strategies in acute aortic dissection: an analysis of the UK National Adult Cardiac Surgical Audit

Abstract   OBJECTIVES The risk of brain injury following surgery for type A aortic dissection (TAAD) remains substantial and no consensus has still been reached on which neuroprotective technique should be preferred. We aimed to investigate the association between neuroprotective strategies and clin...

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Published in:European journal of cardio-thoracic surgery 2021-12, Vol.60 (6), p.1437-1444
Main Authors: Benedetto, Umberto, Dimagli, Arnaldo, Cooper, Graham, Uppal, Rakesh, Mariscalco, Giovanni, Krasopoulos, George, Goodwin, Andrew, Trivedi, Uday, Kendall, Simon, Sinha, Shubhra, Fudulu, Daniel, Angelini, Gianni D, Tsang, Geoffrey, Akowuah, Enoch
Format: Article
Language:English
Subjects:
Adult
Aneurysm, Dissecting - epidemiology
Aneurysm, Dissecting - etiology
Aneurysm, Dissecting - surgery
Aorta, Thoracic - surgery
Cerebrovascular Circulation
Circulatory Arrest, Deep Hypothermia Induced - methods
Conventional Aortic Surgery
Hospital Mortality
Humans
Perfusion - methods
Retrospective Studies
Treatment Outcome
United Kingdom - epidemiology
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Summary:Abstract   OBJECTIVES The risk of brain injury following surgery for type A aortic dissection (TAAD) remains substantial and no consensus has still been reached on which neuroprotective technique should be preferred. We aimed to investigate the association between neuroprotective strategies and clinical outcomes following TAAD repair. METHODS Using the UK National Adult Cardiac Surgical Audit, we identified 1929 patients undergoing surgery for TAAD (2011–2018). Deep hypothermic circulatory arrest (DHCA) only, unilateral (uACP), bilateral antegrade cerebral perfusion (bACP) and retrograde cerebral perfusion were used in 830, 117, 760 and 222 patients, respectively. The primary end point was a composite of death and/or cerebrovascular accident (CVA). Generalized linear mixed model was used to adjust the effect of neuroprotective strategies for other confounders. RESULTS The use of bACP was associated with longer circulatory arrest (CA) compared to other strategies. There was a trend towards lower incidence of death and/or CVA using uACP only for shorter CA. In particular, primary end point rate was 27.7% overall and 26.5%, 12.5%, 28.0% and 22.9% for CA
ISSN:1010-7940
1873-734X
DOI:10.1093/ejcts/ezab192