Selective cerebral perfusion during total hypothermic circulatory arrest in surgical treatment of acute thoracic aortic dissection

Background. Surgical treatment of acute thoracic aortic dissection is often associated with the need for selective cerebral perfusion at the stage of total hypothermic circulatory arrest.

Objective. To establish the preferred method and mode of selective cerebral perfusion (SCP) during complete hypothermic circulatory arrest in surgical treatment of acute thoracic aortic dissection.

Material and methods. Study design: prospective, cohort, single-center. Inclusion criteria: surgical intervention using cardiopulmonary bypass, confirmed diagnosis of acute aortic dissection type A according to Stanford, age > 18 years. The study included 112 patients: 77 men and 32 women aged 31 to 75 years, M±SD=54.79±11.33. All patients (n=112) were treated between 2019 and 2023 and were divided into 3 groups depending on the method of selective cerebral perfusion: antegrade unilateral perfusion (n=51), antegrade bilateral perfusion (n=49), and retrograde perfusion (n=12). The endpoints of the study were cerebrovascular accident (CVA) in the early postoperative period and 30-day in-hospital mortality.

Results. In the bilateral antegrade cerebral perfusion group (biACP), the incidence of CVA in the early postoperative period (p=0.002) and 30-day in-hospital mortality (p=0.006) were statistically significantly lower. Acute cerebral circulatory failure in the postoperative period increases the risk of death by 7.977 times. The volumetric rate of selective perfusion in biACP is a statistically significant predictor of death, and biACP > 12.5 ml/kg/min when calculated for the true body weight according to Broc is associated with an increased risk of hospital mortality.

Conclusions. Bilateral antegrade cerebral perfusion is the preferred technique for selective cerebral perfusion as part of the cardiopulmonary bypass procedure in the surgical treatment of acute thoracic aortic dissection. Restrictive biACP tactics can reduce the risk of 30-day hospital mortality.

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