Comparing unilateral and bilateral cerebral perfusion during total arch replacement for acute type A aortic dissection

Objectives: To assess the effects of unilateral versus bilateral antegrade cerebral perfusion (u-ACP vs b-ACP) on postoperative complications and mid-term follow-up results in Asian patients with acute type A aortic dissection (ATAAD) undergoing total arch replacement (TAR) + the frozen elephant trunk (FET).

Methods: Clinical baseline data and postoperative complications of 702 ATAAD patients undergoing TAR+ FET at China Cardiovascular Centre Fuwai Hospital between January 2019 and December 2022 were collected. Patients were categorized into two groups based on antegrade cerebral perfusion: unilateral (n = 402) and bilateral (n = 300). Propensity scores were matched for 217 pairs of patients. Mid-term and perioperative surgical complications were analyzed, and baseline characteristics between the two groups were assessed.

Results: The matched cohort revealed comparable 30-day mortality rates between u-ACP and b-ACP: 4.15% and 3.23%, respectively (p = 0.61). Rates of postoperative permanent neurologic dysfunction (PND) were similar across groups (2.76% for u-ACP and 3.23% for b-ACP, p = 0.76). However, u-ACP exhibited a higher incidence of postoperative transient neurologic deficit (TND) at 14.29% compared to 6.91% with b-ACP (p = 0.01). Logistic regression models identified u-ACP and cardiopulmonary bypass (CPB) time as independent risk factors for TND. Mid-term survival rates were comparable between the two groups (5-year survival: 90.29% vs 93.67%, p = 0.133).

Conclusions: Both u-ACP and b-ACP are effective brain protection techniques for ATAAD patients undergoing total arch replacement. The use of b-ACP significantly reduces the incidence of TND.