초록접수 현황
| 20F-046 | 구연 발표 |
Unilateral versus Bilateral Antegrade Cerebral Perfusion during Surgical Repair for Patients with Acute Type A Aortic Dissection
¹Seung Jun Song, MD, PhD, ¹Wan Kee Kim, MD, ²Tae-Hoon Kim, MD, ²Suk-Won Song, MD, PhD
¹Department of Cardiothoracic Surgery, Yonsei University Medical Center, Yongin Severance Hospital, Gyeonggi-do, South Korea
²Department of Cardiovascular Surgery, Gangnam Severance Hospital, Seoul, South Korea
Purpose : The impact of bilateral antegrade cerebral perfusion (ACP) on brain protection during acute type A aortic dissection (ATAAD) repair has long been debated.
Methods : We retrospectively reviewed 552 consecutive patients who received selective ACP techniques during lower body ischemia for ATAAD repairs (62.0±14.9 years; 45.7% females) from October 2008 to December 2019. Among these, unilateral or bilateral ACPs were performed in 357 (64.7%) and 165 (35.3%) patients, respectively. Primary interesting of study was set for the occurrence of permanent neurologic dysfunction (PND). Secondary end-point was the detection of transient neurologic dysfunction (TND). For baseline adjustment, propensity-score matching method was used. Multivariable logistic regression analysis was performed to determine the predictive factors for PND.
Results : Total arch replacement was more frequently performed in the unilateral (44.0%) than the bilateral (33.3%) ACP groups (p=0.03). In the crude cohort, the occurrences of PND (7.0% versus 10.3%) and TND (19.6% versus 21.2%) were not significantly different depending on the types of ACPs (unilateral versus bilateral: p=0.70 and 0.65). Propensity-score matching method yielded 113 pairs of patients in each groups. After baseline adjustment, the bilateral ACP did not significantly lower the risks for PND (OR 0.91; 95%CI 0.39-2.11; p=0.83) nor TND (OR 1.33; 95%CI 0.69-2.62; p=0.40) compared with the unilateral ACP. Multivariable risk analysis revealed that only preoperative thrombosed false lumen was inversely associated with the occurrence of PND (OR 0.35; 95%CI 0.13-0.77; p=0.02).
Conclusion : Despite an additional complexity during ATAAD repair, more than one ACP did not offer superiority on the brain protection.
Methods : We retrospectively reviewed 552 consecutive patients who received selective ACP techniques during lower body ischemia for ATAAD repairs (62.0±14.9 years; 45.7% females) from October 2008 to December 2019. Among these, unilateral or bilateral ACPs were performed in 357 (64.7%) and 165 (35.3%) patients, respectively. Primary interesting of study was set for the occurrence of permanent neurologic dysfunction (PND). Secondary end-point was the detection of transient neurologic dysfunction (TND). For baseline adjustment, propensity-score matching method was used. Multivariable logistic regression analysis was performed to determine the predictive factors for PND.
Results : Total arch replacement was more frequently performed in the unilateral (44.0%) than the bilateral (33.3%) ACP groups (p=0.03). In the crude cohort, the occurrences of PND (7.0% versus 10.3%) and TND (19.6% versus 21.2%) were not significantly different depending on the types of ACPs (unilateral versus bilateral: p=0.70 and 0.65). Propensity-score matching method yielded 113 pairs of patients in each groups. After baseline adjustment, the bilateral ACP did not significantly lower the risks for PND (OR 0.91; 95%CI 0.39-2.11; p=0.83) nor TND (OR 1.33; 95%CI 0.69-2.62; p=0.40) compared with the unilateral ACP. Multivariable risk analysis revealed that only preoperative thrombosed false lumen was inversely associated with the occurrence of PND (OR 0.35; 95%CI 0.13-0.77; p=0.02).
Conclusion : Despite an additional complexity during ATAAD repair, more than one ACP did not offer superiority on the brain protection.
책임저자: Suk-Won Song
Department of Cardiovascular Surgery, Gangnam Severance Hospital, Yonsei University College of Medicine
발표자: Seung Jun Song, E-mail : songseungjun@yuhs.ac