Jing Lin1, Zhen Qin1, Xinhao Liu1, Jiyue Xiong1, Zhong Wu2, Yingqiang Guo2, Deying Kang3, Lei Du4. 1. Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China. 2. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China. 3. Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, No. 37, Guo Xue Alley, Chengdu, 610041, Sichuan, China. 4. Department of Anesthesiology, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan, China. dulei@scu.edu.cn.
Abstract
OBJECTIVES:Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes. METHODS: This pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products. RESULTS:A total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21-1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10-0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group. CONCLUSIONS:RIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications. TRIAL REGISTRATION: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786 .
RCT Entities:
OBJECTIVES: Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes. METHODS: This pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products. RESULTS: A total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21-1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10-0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group. CONCLUSIONS:RIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications. TRIAL REGISTRATION: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018-Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786 .
Entities:
Keywords:
Antegrade cerebral perfusion; Retrograde inferior vena caval perfusion; Total aortic arch replacement surgery
Authors: John G Augoustides; Thomas F Floyd; Michael L McGarvey; E Andrew Ochroch; Alberto Pochettino; Shelly Fulford; Andrew J Gambone; Justin Weiner; Sushma Raman; Joseph S Savino; Joseph E Bavaria; David R Jobes Journal: J Cardiothorac Vasc Anesth Date: 2005-08 Impact factor: 2.628
Authors: Z Shenkman; A Elami; Y G Weiss; L Glantz; E Milgalter; B Drenger; F A Burrows; Y Shir Journal: Can J Anaesth Date: 1997-10 Impact factor: 5.063
Authors: C Hagl; M A Ergin; J D Galla; S L Lansman; J N McCullough; D Spielvogel; P Sfeir; C A Bodian; R B Griepp Journal: J Thorac Cardiovasc Surg Date: 2001-06 Impact factor: 5.209
Authors: Bradley G Leshnower; Richard J Myung; Patrick D Kilgo; Thomas A Vassiliades; J David Vega; Vinod H Thourani; John D Puskas; Robert A Guyton; Edward P Chen Journal: Ann Thorac Surg Date: 2010-08 Impact factor: 4.330
Authors: George J Arnaoutakis; Azra Bihorac; Tomas D Martin; Philip J Hess; Charles T Klodell; A Ahsan Ejaz; Cyndi Garvan; Curtis G Tribble; Thomas M Beaver Journal: J Thorac Cardiovasc Surg Date: 2007-10-29 Impact factor: 5.209