P039. Antegrade selective cerebral perfusion in aortic arch surgery: how outcomes change according to different Kazui's flow? A two-center analysis.
Presented During: POD Abstracts (Available for viewing in the exhibit hall for the duration of the meeting)
S. Orsola Hospital
Bologna, Bologna
Italy - Contact Me
Giacomo Murana joined the residency program in cardiac surgery at Alma Mater Studiorum - University of Bologna. During the training he participate as fellow at the Cardiothoracic Surgery Dpt. in St. Antonious Ziekenhuis, Nieuwegein, The Netherlands. Currently, he is a staff member of the Division of Cardiac Surgery at IRCCS-Azienda Ospedaliera Universitaria di Bologna Directed by Prof. D. Pacini at S. Orsola Hospital in Bologna, Italy. His areas of interest are aortic and vascular surgery, endovascular and hybrid techniques for the treatment of the arch and thoraco-abdominal diseases.
Thursday, April 25, 2024: 5:38 PM - 7:00 PM
Sheraton Times Square
Room: Central Park
Description
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 62.412.7 in LF and 63.512.5 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.
Authors
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)
Institutions
(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
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 62.412.7 in LF and 63.512.5 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.
Authors
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)
Institutions
(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
Presentation Duration
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