Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery : based on the Japan Adult Cardiovascular Surgery Database

• Published in: General thoracic and cardiovascular surgery Vol. 60; no. 3; pp. 132 - 139
• Main Authors: Usui, Akihiko, Miyata, Hiroaki, Ueda, Yuichi, Motomura, Noboru, Takamoto, Shinichi
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Nature B.V 01.03.2012
• Subjects: Aortic surgery; Brain protection; Clinical outcomes; Heart surgery; Mortality; Regression analysis; Stroke; Japan
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-011-0857-2

PurposeAntegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two major types of brain protection for aortic arch surgery. A large-scale clinical study of RCP and ACP is important to clarify the respective characteristics for major adverse events. We conducted a comparative study to evaluate up-to-date clinical outcomes in Japan based on the Japan Adult Cardiovascular Surgery Database (JACVSD).MethodsThe subjects were confined to cases undergone electively with ACP or RCP for nondissection aneurysms in the ascending aorta and aortic arch between 2005 and 2008 from 13 467 aortic surgeries. There were 2209 ACP cases and 583 RCP cases. A risk-adjusted comparison based on 30-day mortality, operative mortality, and major morbidity was assessed by a multivariable logistic regression analysis. A conditional logistic regression analysis was also conducted in 499 propensity matched-pairs with ACP and RCP.ResultsA risk-adjusted analysis showed no significant differences between the ACP and RCP groups regarding 30-day mortality (3.5% vs. 2.6%), operative mortality (5.3% vs. 4.1%), or stroke (6.8% vs. 3.1%). Propensity-matched pairs also revealed no significant differences between ACP and RCP regarding 30-day mortality (3.4% vs. 2.4%), operative mortality (3.8% vs. 3.4%), or stroke rate (5.0% vs. 3.0%); however, RCP resulted in a significantly higher rate of transient neurological dysfunction (3.0% vs. 5.8%) and need for dialysis (1.6% vs. 4.2%).ConclusionBoth RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates. RCP resulted in a higher incidence only in patients demonstrating transient neurological dysfunction and the need for dialysis.