Shulei Fan1, Hongbo Li2, Daoxin Wang1, Chun Wu3, Zhengxia Pan3, Yonggang Li3, Yong An3, Gang Wang3, Jiangtao Dai3, Quan Wang4. 1. Chongqing Medical University, Chongqing, China; Department of Respiratory Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China. 2. Chongqing Medical University, Chongqing, China; Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China. 3. Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China. 4. Chongqing Medical University, Chongqing, China; Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Pediatrics, Chongqing Medical University, Chongqing, China. Electronic address: 1024068781@qq.com.
Abstract
BACKGROUND: Reliable brain protection during proximal aortic surgery remains a formidable surgical challenge. Various cerebral protection techniques have been used in the clinic; however, there is no consensus regarding which strategy is best. In this network meta-analysis (NMA), we focused on permanent neurological deficits (PND) and perioperative mortality associated with four major brain protection strategies used during proximal aortic surgery. METHODS: We performed a literature search of the MEDLINE, Embase, Cochrane Library and PubMed databases. The primary outcomes of this analysis were PND and perioperative mortality. Network rank and surface under the cumulative ranking curve (SUCRA) analyses were performed to evaluate and identify the superiority of different brain protection techniques. RESULTS: Thirty-two studies involving 6772 participants were included in this review. The number of studies that involved DHCA, DHCA + ACP, DHCA + RCP and MHCA + ACP were 16, 19, 23 and 15, respectively. Based on SUCRA analyses, moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA + ACP) was the best choice in terms of PND (predictive probabilities: 77.5), and deep hypothermic circulatory arrest with retrograde cerebral perfusion (DHCA + RCP) was the best choice in terms of mortality (predictive probabilities: 65.4). Deep hypothermic circulatory arrest (DHCA) alone was inferior to the other techniques in terms of both PND and mortality. CONCLUSIONS: Effective cerebral perfusion should be actively considered. Retrograde perfusion (RCP) can reduce mortality and will not increase risks of PND compared with antegrade perfusion (ACP) when performing DHCA. Moderate hypothermia should be recommended when performing ACP. DHCA + RCP and MHCA + ACP seem to be appropriate brain protection strategies during proximal aortic surgery and more clinical studies involving pairwise comparisons between them are needed.
BACKGROUND: Reliable brain protection during proximal aortic surgery remains a formidable surgical challenge. Various cerebral protection techniques have been used in the clinic; however, there is no consensus regarding which strategy is best. In this network meta-analysis (NMA), we focused on permanent neurological deficits (PND) and perioperative mortality associated with four major brain protection strategies used during proximal aortic surgery. METHODS: We performed a literature search of the MEDLINE, Embase, Cochrane Library and PubMed databases. The primary outcomes of this analysis were PND and perioperative mortality. Network rank and surface under the cumulative ranking curve (SUCRA) analyses were performed to evaluate and identify the superiority of different brain protection techniques. RESULTS: Thirty-two studies involving 6772 participants were included in this review. The number of studies that involved DHCA, DHCA + ACP, DHCA + RCP and MHCA + ACP were 16, 19, 23 and 15, respectively. Based on SUCRA analyses, moderate hypothermic circulatory arrest with antegrade cerebral perfusion (MHCA + ACP) was the best choice in terms of PND (predictive probabilities: 77.5), and deep hypothermic circulatory arrest with retrograde cerebral perfusion (DHCA + RCP) was the best choice in terms of mortality (predictive probabilities: 65.4). Deep hypothermic circulatory arrest (DHCA) alone was inferior to the other techniques in terms of both PND and mortality. CONCLUSIONS: Effective cerebral perfusion should be actively considered. Retrograde perfusion (RCP) can reduce mortality and will not increase risks of PND compared with antegrade perfusion (ACP) when performing DHCA. Moderate hypothermia should be recommended when performing ACP. DHCA + RCP and MHCA + ACP seem to be appropriate brain protection strategies during proximal aortic surgery and more clinical studies involving pairwise comparisons between them are needed.
Authors: Daniel M Spielman; Meng Gu; Ralph E Hurd; R Kirk Riemer; Kenichi Okamura; Frank L Hanley Journal: NMR Biomed Date: 2022-05-18 Impact factor: 4.478
Authors: Djamila Abjigitova; Kevin M Veen; Gabriëlle van Tussenbroek; Mostafa M Mokhles; Jos A Bekkers; Johanna J M Takkenberg; Ad J J C Bogers Journal: Interact Cardiovasc Thorac Surg Date: 2022-08-03