Comparing unilateral and bilateral cerebral perfusion during total arch replacement for acute type A aortic dissection

OBJECTIVES To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs. b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET).METHODS Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR + FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on ACP: unilateral (n = 402) and bilateral (n = 300). Propensity scores were matched for 217 pairs of patients. Mid-term and perioperative surgical complications were analysed, and baseline characteristics between the two groups were assessed.RESULTS The matched cohort revealed comparable 30-day mortality rates between u-ACP and b-ACP: 4.15% and 3.23%, respectively (P = 0.61). Rates of postoperative permanent neurologic dysfunction (PND) were similar across groups (2.76% for u-ACP and 3.23% for b-ACP, P = 0.76). However, u-ACP exhibited a higher incidence of postoperative transient neurologic deficit (TND) at 14.29% compared to 6.91% with b-ACP (P = 0.01). Logistic regression models identified u-ACP and cardiopulmonary bypass (CPB) time as independent risk factors for TND. Mid-term survival rates were comparable between the two groups (5-year survival: 90.29% vs. 93.67%, P = 0.133).CONCLUSIONS Both u-ACP and b-ACP are effective brain protection techniques for ATAAD patients undergoing TAR. The use of b-ACP significantly reduces the incidence of TND. The acute condition known as acute type A aortic dissection (ATAAD) requires urgent surgical intervention and is associated with substantial mortality rates (22%) [1] and neurological complications (5-15%) [2-4].