article · European Heart Journal Supplements
This prospective cohort study investigated the effectiveness of retrograde cerebral perfusion (RCP) in 43 patients undergoing emergency surgery for Type A aortic dissection. The aim was to assess early post-operative neurological complications and surgical mortality. Patients received RCP during deep hypothermic circulatory arrest. Results showed an overall hospital mortality of 27.9%. Regarding neurological outcomes, 51.2% of patients regained full consciousness, while 25.6% were semi-conscious or confused, and 9.3% were comatose. Key risk factors for adverse neurological outcomes and mortality included older age, prolonged bypass and cross-clamp times, significant post-operative bleeding, and renal impairment. The study concluded that RCP is a simple and reliable brain protection method, potentially superior to antegrade perfusion due to its technical simplicity, speed, and reduced risk of embolic events.
Type A aortic dissection is a critical condition requiring complex surgery with high risks of death and neurological damage. This research evaluates a specific brain protection technique, retrograde cerebral perfusion, which is crucial for improving patient outcomes. Understanding its effectiveness and associated risk factors can help refine surgical practices and enhance patient safety.
This research evaluates an established surgical technique, retrograde cerebral perfusion, for brain protection during complex cardiac surgery. The findings provide evidence for its effectiveness and potential advantages over other methods, which could inform clinical guidelines and surgical training programmes. This is applied research, directly relevant to medical practitioners and hospital organisations, aiming to improve patient care and outcomes in a highly specialised field.
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Abstract Background Type A aortic dissection is a life-threatening emergency with a mortality risk increasing 1–2% every hour without surgical intervention. Surgery carries high risk of mortality (approx. 17–25% in-hospital) and major morbidity, with significant neurological complications being most common occurring in 6–23% of cases. Brain protection remains one of the most challenging aspects during surgery Retrograde cerebral perfusion (RCP) is a neuroprotective technique used during deep hypothermic circulatory arrest (DHCA) in complex thoracic aortic arch surgeries. It was first used in 1980 by Mills and Ochsner to treat accidental air embolisms. The first time it was used for cerebral protection in thoracic aortic surgeries was in 1990 by Ueda and colleagues Aim and Objectives Assess early post-operative neurological complications and surgical mortality in patients receiving retrograde cerebral protection during surgical repair for Type A Aortic dissect Methods We Conducted Prospective Cohort study on 43 patients diagnosed with Acute Type A aortic dissection undergoing emergency surgical repair using Retrograde cerebral perfusion as the brain protection technique. All patients had emergency surgery with Median sternotomy incision, with total circulatory arrest and retrograde cerebral perfusion on a core temp of (24–26°C), Patients were recruited over time period of 18 months Results 22 patients had supracoronary repair and 21 had modified Bentall with a Mean age of 52 and a Male predominance 90%. The overall hospital mortality was 12/43 (27.9%), Regarding neurological outcomes 22 patients(51.2%) regained full consciousness,15 of them in the 1st 24 h and 7 in(1–4 days), 11 patients(25.6%) were semi-conscious or confused and 4 3patients (9.3%) were comatose, semi-conscious patients had various neurological complications, (48.8%) had significant bleeding, (14%) suffered renal impairment post-operative.,Chest was left open in (79.1%) of cases. Mean Bypass time was 215 min, Mean Cross Clamp time was 133 min and mean Deep Hypothermic Circulatory Arrest time was 30 min Conclusions The Predominant risk factors for adverse neurological outcomes and mortality included old age, prolonged Bypass/ cross clamp time, significant post-operative bleeding and post-operative renal impairment. There was also strong correlation between hypercholesterolemia and neurological complications. Retrograde cerebral perfusion is a simple and reliable method for brain protection Covering a deep hypothermic circulatory arrest for up to 55–60 min. It is superior to Ante grade in being technically simpler and faster, less risk of embolic events or strokes, better metabolic support for the brain
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DOI: 10.1093/eurheartjsupp/suag109.006
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