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Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis.

Publication ,  Journal Article
Ganapathi, AM; Hanna, JM; Schechter, MA; Englum, BR; Castleberry, AW; Gaca, JG; Hughes, GC
Published in: J Thorac Cardiovasc Surg
December 2014

OBJECTIVE: The choice of cerebral perfusion strategy for aortic arch surgery has been debated, and the superiority of antegrade (ACP) or retrograde (RCP) cerebral perfusion has not been shown. We examined the early and late outcomes for ACP versus RCP in proximal (hemi-) arch replacement using deep hypothermic circulatory arrest (DHCA). METHODS: A retrospective analysis of a prospectively maintained database was performed for all patients undergoing elective and nonelective hemiarch replacement at a single referral institution from June 2005 to February 2013. Total arch cases were excluded to limit the analysis to shorter DHCA times and a more uniform patient population for whom clinical equipoise regarding ACP versus RCP exists. A total of 440 procedures were identified, with 360 (82%) using ACP and 80 (18%) using RCP. The endpoints included 30-day/in-hospital and late outcomes. A propensity score with 1:1 matching of 40 pre- and intraoperative variables was used to adjust for differences between the 2 groups. RESULTS: All 80 RCP patients were propensity matched to a cohort of 80 similar ACP patients. The pre- and intraoperative characteristics were not significantly different between the 2 groups after matching. No differences were found in 30-day/in-hospital mortality or morbidity outcomes. The only significant difference between the 2 groups was a shorter mean operative time in the RCP cohort (P = .01). No significant differences were noted in late survival (P = .90). CONCLUSIONS: In proximal arch operations using DHCA, equivalent early and late outcomes can be achieved with RCP and ACP, although the mean operative time is significantly less with RCP, likely owing to avoidance of axillary cannulation. Questions remain regarding comparative outcomes with straight DHCA and lesser degrees of hypothermia.

Duke Scholars

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

December 2014

Volume

148

Issue

6

Start / End Page

2896 / 2902

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Registries
  • Propensity Score
  • Perfusion
  • Middle Aged
  • Male
 

Citation

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Ganapathi, A. M., Hanna, J. M., Schechter, M. A., Englum, B. R., Castleberry, A. W., Gaca, J. G., & Hughes, G. C. (2014). Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis. J Thorac Cardiovasc Surg, 148(6), 2896–2902. https://doi.org/10.1016/j.jtcvs.2014.04.014
Ganapathi, Asvin M., Jennifer M. Hanna, Matthew A. Schechter, Brian R. Englum, Anthony W. Castleberry, Jeffrey G. Gaca, and G Chad Hughes. “Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis.J Thorac Cardiovasc Surg 148, no. 6 (December 2014): 2896–2902. https://doi.org/10.1016/j.jtcvs.2014.04.014.
Ganapathi AM, Hanna JM, Schechter MA, Englum BR, Castleberry AW, Gaca JG, et al. Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis. J Thorac Cardiovasc Surg. 2014 Dec;148(6):2896–902.
Ganapathi, Asvin M., et al. “Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis.J Thorac Cardiovasc Surg, vol. 148, no. 6, Dec. 2014, pp. 2896–902. Pubmed, doi:10.1016/j.jtcvs.2014.04.014.
Ganapathi AM, Hanna JM, Schechter MA, Englum BR, Castleberry AW, Gaca JG, Hughes GC. Antegrade versus retrograde cerebral perfusion for hemiarch replacement with deep hypothermic circulatory arrest: does it matter? A propensity-matched analysis. J Thorac Cardiovasc Surg. 2014 Dec;148(6):2896–2902.
Journal cover image

Published In

J Thorac Cardiovasc Surg

DOI

EISSN

1097-685X

Publication Date

December 2014

Volume

148

Issue

6

Start / End Page

2896 / 2902

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Time Factors
  • Risk Factors
  • Retrospective Studies
  • Respiratory System
  • Registries
  • Propensity Score
  • Perfusion
  • Middle Aged
  • Male