Bilateral or Unilateral Antegrade Cerebral Perfusion During Surgery for Acute Type a Dissection

Abstract Objective To investigate outcomes associated with the application of either bilateral or unilateral antegrade cerebral perfusion (b-ACP, u-ACP) during surgery for acute type A dissection (TAD). Methods Patients who underwent surgery for TAD with the application of ACP between 2009 and 2017 at the Division of Cardiac Surgery, Medical University of Vienna were analyzed retrospectively (b-ACP: n = 91, 49.5%; u-ACP: n = 93, 50.5%). The primary outcome variable was overall survival. Additionally, sub-group analyses were performed in patients requiring ACP durations ≥ 50 min and Results Multivariable Cox proportional hazards analysis demonstrated no significant association of b-ACP with overall survival (hazard ratio [HR] 0.63, 95% confidence interval [CI] 0.34 – 1.14, p = 0.126). Propensity score modelling using the method of inverse probability of treatment weighting confirmed this result (HR 0.73, 95% CI 0.33 – 1.60, p = 0.428). Bilateral ACP was associated with significantly improved overall survival in patients requiring ACP durations ≥ 50 min (p = 0.017). The b-ACP and u-ACP groups showed comparable rates of secondary outcome variables. Conclusions In the present study, b-ACP and u-ACP are associated with comparable outcomes after surgery for TAD. Sub-group analyses suggest that b-ACP is associated with superior overall survival in patients requiring ACP durations ≥ 50 min. An adequately powered prospective randomized controlled trial is required to validate these results.