Antegrade Cerebral Perfusion And Retrograde Cerebral Perfusion In Acute Stanford Type A Aortic Dissection Comparison Of Brain Protection Effect

ObjectiveAortic dissection(AD)is a common and fatal disease both at home and abroad,but it is often misdiagnosed.acute Stanford type A aortic dissection(ATAAD)usually requires emergency surgery.Postoperative complications of acute type A aortic dissection mainly include heart-related complications,postoperative bleeding,acute kidney injury,and neurological complications.Among them,the more common and serious neurological complications,the incidence and severity of which are closely related to the intraoperative brain protective measures.Currently,the main methods of intraoperative cerebral perfusion at home and abroad include deep hypothermic circulatory arrest(DHCA)combined with antegrade cerebral perfusion,ACP)or retrograde cerebral perfusion(RCP),but the pros and cons of DHCA combined with ACP or RCP on brain protection have been controversial.Therefore,this study analyzed part of the data related to type A aortic dissection in the heart Great vascular Center of our hospital,hoping that our research results could provide more accurate analysis and understanding of the intraoperative brain protection methods of ATAAD,improve the intraoperative brain protection effect of ATAAD to a certain extent,and reduce postoperative neurological complications.MethodsA total of 43 ATAAD patients admitted to our hospital from January 2021 to February2023 were retrospectively analyzed.According to intraoperative brain protection methods,patients were divided into anterograde perfusion group and retrograde perfusion group,including 25 cases in the ACP group and 18 cases in the RCP group.The clinical data of enrolled patients were collected and the brain protective effects of the two groups were compared.The data obtained in this study were input into SPSS26.0 software for processing,and the data of all indicators were tested.The results were expressed as 95% confidence interval,and P < 0.05 indicated statistically significant differences.ResultsThe collected preoperative data were summarized and analyzed,including 17 cases of hypertension in the ACP group and 14 cases of hypertension in the RCP group.Preliminary statistics on the basic data of the subjects in the two groups showed that the ages were 29-78 years old and 29-75 years old,respectively(P < 0.05).There were 13 and 3 cases over 60 years old,accounting for 52% and 16.7%,respectively.The average preoperative time in ACP group was(614.32±423.77min).The mean preoperative time of RCP group was 495.06±319.79 min.There was no difference in preoperative time between the two groups(P > 0.05).The operative time of ACP group and RCP group was 275-530 min and 371-625 min,respectively,with an average of 419.40±59.94 min and 475.72±70.16 min,indicating a certain difference between the two groups(P < 0.05).The CPB time of ACP group and RCP group was151-303 min and 177-373 min,respectively,and the comparative analysis showed that the data of the two groups were significantly different(P < 0.05).In terms of DHCA time,further statistical analysis showed that in the ACP group,12 patients(48%)were within 38 min and 13 patients(52%)were above 38 min.In the RCP group,10 patients(55.6%)were within 38min(including 38min),and 5 patients(44.4%)were above38 min.Combined with the above results,there was no significant difference between the two groups(P > 0.05).In addition to the above indexes,the time of aortic occlusion was also compared and analyzed.The time of aortic occlusion in ACP group and RCP group was 70-248 min and 133-271 min,respectively,with an average of 223.20±40.21 min and 40.06±58.16 min,respectively.Therefore,there was no difference in aortic occlusion time(P > 0.05).(See Table 2 for details).Surgical incision: One patient in the ACP group developed numbness in the right upper limb after surgery,and there were no other abnormalities.In this paper,the postoperative extubation time,ICU stay time and total stay time of the two groups were compared and analyzed to determine whether there were significant differences.The extubation time was 465-9210 min and 930-9043 min respectively,and the average extubation time was 3732.84±2771.26 min and 4793.83±2537.95 min,respectively.There was no difference between the two groups(P > 0.05).The length of ICU stay was 2-28 days and 4-46 days,with an average of 9.80±7.72 days and 10.78±9.70 days,respectively,with no significant difference(P > 0.05).The length of hospitalization was 11-44 days and 12-62 days,respectively,with an average of 23.44±8.24 days and 29.67±12.38 days,with no significant difference(P > 0.05).ConclusionThis study found that there was no significant difference in the incidence of postoperative neurological dysfunction(ND)between DHCA combined with ACP and DHCA combined with RCP during ATAAD surgery.In addition,no matter what cerebral perfusion method was used during surgery,it had little influence on extubation time and ICU stay time.As for the two modes of cerebral perfusion,we believe that ACP or RCP and DHCA can ideally protect neurological function,reduce the incidence of stroke,and reduce the risk of terminal organ complications.At present,Sun’s operation has become the standard operation method for type A aortic dissection involving descending aorta.With the progress of brain protection awareness and measures,the incidence of postoperative nerve dysfunction will be effectively controlled.