Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery : Nationwide Analysis in Japan

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  • Brain Protection During Ascending Aortic Repair for Stanford Type A Acute Aortic Dissection Surgery
  • – Nationwide Analysis in Japan –

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Background:The optimal brain protection strategy for use during acute type A aortic dissection surgery is controversial.Methods and Results:We reviewed the results for 2 different methods: antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP), during ascending aortic repair for acute type A aortic dissection for the period between 2008 and 2012 nationwide. Cases involving root repair, arch vessel reconstruction and/or concomitant procedures were excluded. Using the Japan Adult Cardiovascular Surgery Database, a total of 4,128 patients (ACP, n=2,769; RCP, n=1,359; mean age, 69.1±11.8 years; male 41.9%) were identified. The overall operative mortality was 8.6%. Following propensity score matching, among 1,320 matched pairs, differences in baseline characteristics between the 2 patient groups diminished. Cardiac arrest time (ACP 116±36 vs. RCP102±38 min, P<0.001), perfusion time (192±54 vs. 174±53 min, P<0.001) and operative time (378±117 vs. 340±108 min, P<0.001) were significantly shorter in the RCP group. There were no significant differences between the 2 groups regarding the incidence of operative mortality or neurological complications, including stroke (ACP 11.2% vs. RCP 9.7%). Postoperative ventilation time was significantly longer in the ACP group (ACP 128.9±355.7 vs. RCP 98.5±301.7 h, P=0.018). There were no differences in other early postoperative complications, such as re-exploration, renal failure, and mediastinitis.Conclusions:Among patients undergoing dissection repair without arch vessel reconstruction, RCP had similar mortality and neurological outcome to ACP. (Circ J 2014; 78: 2431–2438)

収録刊行物

  • Circulation Journal

    Circulation Journal 78 (10), 2431-2438, 2014

    一般社団法人 日本循環器学会

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