Emiliano Angeloni1, Umberto Benedetto2, Johanna J M Takkenberg3, Ivan Stigliano2, Antonino Roscitano2, Giovanni Melina2, Riccardo Sinatra2. 1. Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy. Electronic address: emilianoangeloni@gmail.com. 2. Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy. 3. Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Abstract
OBJECTIVE: Our objective was to determine whether the use of unilateral (u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in different mortality and neurologic outcomes after complex aortic surgery. METHODS: PubMed, Embase, and the Cochrane Library were searched for studies reporting on postoperative mortality and permanent (PND) and temporary neurologic dysfunction (TND) in complex aortic surgery requiring circulatory arrest with antegrade cerebral protection. Analysis of heterogeneity was performed with the Cochrane Q statistic. RESULTS: Twenty-eight studies were analyzed for a total of 1894 patients receiving u-ACP versus 3206 receiving b-ACP. Pooled analysis showed similar rates of 30-day mortality (8.6% vs 9.2% for u-ACP and b-ACP, respectively; P = .78), PND (6.1% vs 6.5%; P = .80), and TND (7.1% vs 8.8%; P = .46). Age, sex, and cardiopulmonary bypass time did not influence effect size estimates. Higher rates of postoperative mortality and PND were among nonelective operations and for highest temperatures and duration of the circulatory arrest. The Egger test excluded publication bias for the outcomes investigated. CONCLUSIONS: This meta-analysis shows that b-ACP and u-ACP have similar postoperative mortality and both PND and TND rates after circulatory arrest for complex aortic surgery.
OBJECTIVE: Our objective was to determine whether the use of unilateral (u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in different mortality and neurologic outcomes after complex aortic surgery. METHODS: PubMed, Embase, and the Cochrane Library were searched for studies reporting on postoperative mortality and permanent (PND) and temporary neurologic dysfunction (TND) in complex aortic surgery requiring circulatory arrest with antegrade cerebral protection. Analysis of heterogeneity was performed with the Cochrane Q statistic. RESULTS: Twenty-eight studies were analyzed for a total of 1894 patients receiving u-ACP versus 3206 receiving b-ACP. Pooled analysis showed similar rates of 30-day mortality (8.6% vs 9.2% for u-ACP and b-ACP, respectively; P = .78), PND (6.1% vs 6.5%; P = .80), and TND (7.1% vs 8.8%; P = .46). Age, sex, and cardiopulmonary bypass time did not influence effect size estimates. Higher rates of postoperative mortality and PND were among nonelective operations and for highest temperatures and duration of the circulatory arrest. The Egger test excluded publication bias for the outcomes investigated. CONCLUSIONS: This meta-analysis shows that b-ACP and u-ACP have similar postoperative mortality and both PND and TND rates after circulatory arrest for complex aortic surgery.
Authors: Elizabeth L Norton; Xiaoting Wu; Karen M Kim; Himanshu J Patel; G Michael Deeb; Bo Yang Journal: J Thorac Cardiovasc Surg Date: 2019-09-05 Impact factor: 5.209