Unilateral and bilateral cerebral perfusion during total arch replacement surgery: which is better?

P0365 

Abstract Submission 

Juntao Qiu (1), Yumeng Ji (2), Cuntao Yu (3)

(1) N/A, China, (2) Fuwai Hospital, Beijing, Beijing, (3) Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular, Beijing, Beijing

Juntao Qiu    -  Contact Me
N/A

Yumeng Ji    -  Contact Me
Fuwai Hospital

CUNTAO YU    -  Contact Me
Fuwai Hospital, National Centre for Cardiovascular Diseases, State Key Laboratory of Cardiovascular

Yumeng Ji    -  Contact Me
Fuwai Hospital

Objectives: To compare the impact of unilateral antegrade cerebral perfusion (uni-ACP) and bilateral antegrade cerebral perfusion (bi-ACP) on perioperative complications and short-term follow-up outcomes in Asian patients of total arch replacement surgery.
Methods: We retrospectively collected clinical baseline characteristics and perioperative complications of 1052 patients who underwent total arch replacement surgery in China Cardiovascular Center-Fuwai Hospital from January 2019 to December 2022. Patients were separated into unilateral (n=448) and bilateral (n=604) antegrade cerebral perfusion groups We selected 372 pairs of patients for propensity score matching and evaluated baseline differences between the two groups and analyze perioperative and short-term postoperative complications such as bleeding, infection, redissection and organ damage, especially neurological injury such as cerebrovascular accident(CVA), delirium, etc.
Results: Perioperative mortality and postoperative complications such bleeding, infection, and redissection were similar between groups with a 30-day mortality of 8.5% for uni-ACP versus 9.2% for bi-ACP (P=0.46). Notably, the incidence of postoperative delirium was significantly lower in the uni-ACP group (5% vs. 12%, p=0.03). Between uni-ACP and bi-ACP groups, overall CVA rate (4.3% vs. 3.8%, p=0.4) were not significantly different. The short-term survival was similar between the two groups, p=0.27, (1-year:93.4% vs. 94.2%).
conclusions: In total arch replacement surgery, both uni-ACP and bi-ACP are considered valid strategies for brain protection. Notably, the use of bi-ACP demonstrates a significant reduction in the incidence of postoperative delirium.

Cerebral Protection