Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion during deep hypothermic circulatory arrest in aortic surgery: a meta-analysis of 7023 patients

Artificial Organs
Shasha GuoZhe Zheng

Abstract

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 ...Continue Reading

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Citations

Sep 14, 2015·The Annals of Thoracic Surgery·Konstantinos PerreasAndreas Bairaktaris
Mar 8, 2016·Artificial Organs·Paul S Malchesky
Mar 10, 2017·Anesthesia and Analgesia·Robert H Thiele
Oct 16, 2016·Seminars in Cardiothoracic and Vascular Anesthesia·Matthew S MoscaT Brett Reece
Apr 23, 2020·Minerva cardioangiologica·Cristiano SpadaccioMario F Gaudino
Jan 27, 2021·Heart, Lung & Circulation·George SamanidisKonstantinos Perreas
Mar 25, 2019·The Journal of Thoracic and Cardiovascular Surgery·Irbaz HameedMario Gaudino

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