Antegrade selective cerebral perfusion in aortic arch surgery: how outcomes change according to different Kazui’s flow? A two-center analysis.

P0039 

Abstract Submission 

Giacomo Murana (1), Sabrina Castagnini (1), Kavya Rajesh (2), Costanza Fiaschini (1), Francesco Campanini (1), Edoardo Bianco (1), Yu Hohri (2), Dov Levine (2), Hiroo Takayama (3), Davide Pacini (1)

(1) IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna, Bologna, Italy, (2) Columbia University Irving Medical Center, New York, NY, (3) NewYork- Presbyterian/Columbia University Medical Center, New York, NY

Giacomo Murana    -  Contact Me
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna

Sabrina Castagnini    -  Contact Me
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna

Kavya Rajesh    -  Contact Me
Columbia University Irving Medical Center

Costanza Fiaschini    -  Contact Me
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna

Francesco Campanini    -  Contact Me
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna

Edoardo Bianco    -  Contact Me
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna

Yu Hohri    -  Contact Me
Columbia University Irving Medical Center

Dov Levine    -  Contact Me
Columbia University Irving Medical Center

*Hiroo Takayama    -  Contact Me
NewYork- Presbyterian/Columbia University Medical Center

*Davide Pacini    -  Contact Me
IRCCS Azienda Ospedaliero-Universitaria di Bologna, Alma Mater Studiorum Università di Bologna

Giacomo Murana    -  Contact Me
S. Orsola Hospital

Objective: Antegrade selective cerebral perfusion (ASCP) is one of the strategies employed for cerebral protection during aortic arch surgery. The aim of this study is to establish the relationship between ASCP average flow and cerebral damage, considering both transient (TND) and permanent (PND) neurological deficits.

Methods: The cohort of this retrospective study includes patients from two centers: Cardiac Surgery Department of Policlinico Sant'Orsola, Bologna, and Columbia Irving Medical Center, New York. Data collected include patients who underwent aortic arch surgery using ASCP and moderate hypothermia from January 2015 to August 2023. Patients have been divided into two groups according to ASCP flow rate: low-flow (LF) with a flow <10ml/kg/min and high-flow (HF) with a flow 10ml/kg/min. Neurological complications have been distinguished into PND and TND analyzing both clinical and radiological aspects. Early postoperative outcomes were evaluated. Late mortality has been compared through Kaplan-Meier survival curves.

Results: A total of 712 patients were included in a retrospective study, LF 67(9.4%) and HF 645(90.6%). The mean age was 62.412.7 in LF and 63.512.5 in HF. The analysis of risk factors showed that HTN was significantly higher in LF (55, 82.1%) than in HF (465, 72.1%), p=0.042. Preoperative data showed a higher rate in HF of bicuspid aortic valve (LF 3(4.5%), HF 67(10.0%), p= 0.034) and reintervention (LF 10(14.9%), HF 174(27.0%), p=0.010). Aneurysm was the main indication for surgery in HF (LF 18(26.9%), HF 325(50.4%), p<0.001), while Acute Type A aortic dissection (ATAAD) was more frequent in LF (LF 40(59.7%), HF 226(35.0%), p<0.001). The main site of arterial cannulation was femoral artery in LF (LF 24(35.8%), HF 142(22.0%), p=0.031), and brachiocephalic trunk in HF (LF 8(11.9%), HF 163(25.3%), p=0.009). Concerning neurological complications, no significant differences were found between the two groups: TND was higher in LF (LF 13(19.4%), HF 96 (14.9%), p=0.270), PND and ischemic stroke were similar (respectively LF 6(9.0%), HF 61(9.5%), p= 0.865 and LF 4(7.5%), HF 31(8.8%), p= 0.680) and hemorrhagic stroke was lower in LF (LF 1(20.0%), HF 24 (42.1%), p=0.175). No significant differences were found in survival rate at 60 months.

Conclusions: Despite the limitations of the study, related to different characteristics of the groups, short period of analysis and absence of the exact mean flow for each patient, with our data we have been able to correlate neurological damage to ASCP flow. Although it is not statistically significant, hemorrhagic stroke rate was higher in those patients who received a higher flow.

Cerebral Protection