Comparative Study Of Different Perfusion Methods On Brain Complications In 61 Patients With TAAD

Background and purpose: TAAD(Stanford Type-A Aortic Dissection),a kind of cardiovascular surgery emergency symptom,refers to the inner layer of the aorta tears caused by a serious of pathogenic factors,and blood surges through the tear,causing the inner and middle layers of aorta to separate(dissect)with the trend of aorta or not.The clinical features of TAAD are always shown by acute onset,rapid development,multiple organs involvement and high hospital motality.According to the 2014 ESC Guidelines,the best way to treat TAAD is surgical treatment once the disease has been diagnosed without obvious contraindications.At present,the Sun’s Procedure(general aortic arch replacement & decending aortic elephant trunk stent placement),the major treatment for TAAD,has remarkable effects for many years and reduces the mortality of the disease greatly.However,the incidence of postoperative complications and mortality during hospitalization is still higher than the common heart disease.So,a difficult point in today’s cardiovascular surgery is to reduce the incidence of perioperative complications further,to promote early recovery of patients and to improve the survival rate.The most common and intractable complications of TAAD are postoperative brain complications,TND(Temporary Neurological Dysfunction)and PND(Permanent Neurological Dysfunction),which can prolong the ICU hospitalization time,delay postoperative rehabilitation time and reduce long-term quality of patients’ life significantly,even threat patients’ life.Intraoperative selective cerebral perfusion is a classic method for brain protection,but there is controversy in perfusion techniques and methods;for example,unilateral or bilateral cerebral perfusion,antegrade perfusion or retrograde perfusion,perfusion of blood vessels and Control of cerebral perfusion flow,etc.In recent years,there has been a big divergence on the choice of unilateral(axillary artery to right common carotid artery)and bilateral(right side by axillary artery to right common carotid artery or truncus brachiocephalicus & left side by the left common carotid artery).The advantages and disadvantages of the two cerebral perfusion methods should be explored through clinical multi-center big data.Method:This study used a retrospective analysis of 61 patients who underwent unilateral or bilateral selective cerebral perfusion during surgery with the diagnosis of TAAD in this Center from January 2017 to December 2018,to discuss the effect of different cerebral perfusion method on postoperative brain complications in patients with TAAD.Of the 61 patients with TAAD,44 were male and 17 were female;mean age was 62.95±11.16years(32-79years);48 cases of hypertension,26 cases of aortic regurgitation,5 cases of coronary heart disease,renalfunction There were 7 cases of incompleteness,8 cases of respiratory diseases,2 cases of horse syndrome,and 9 cases of diabetes.They were randomly divided into a unilateral selective cerebral perfusion group and a bilateral selective cerebral perfusion group,including 29 patients in the unilateral selective cerebral perfusion group and 32 patients in the bilateral selective cerebral perfusion group.The data were statistically analyzed using SPSS 22.0 and related statistical methods.Analysis the differences in parameters related to pre-operation(sex,age,history of hypertension,coronary heart disease,renal insufficiency,and aortic insufficiency),intra-operation(surgery time,extracorporeal circulation time,aortic occlusion time,and selective cerebral perfusion time)and post-operation(ventilator assist time,recovery time,blood product use,blood biochemical indicators,transient neurological dysfunction,permanent neurological dysfunction,ICU hospitalization time,and total postoperative hospital stay).Result:This study included 61 patients with TAAD,divided into a unilateral selective cerebral perfusion group and a bilateral cerebral perfusion group.The retrospective analysis method was used to compare the preoperative,intraoperative and postoperative parameters of the patients.(1)The temporary neurological dysfunction rate after unilateral selective cerebral perfusion is higher than bilateral selective cerebral perfusion(37.9% vs 18.8%),the recovery time(10.5±1.3h vs 7.2±0.8h)and the ICU hospitalization time is longer(117.69±30.68 h vs 88.87±34.97h)(p<0.05);(2)There is no significant difference in the permanent neurological dysfunction rate and the mortality during hospitalization after operation using unilateral or bilateral selective cerebral perfusion(p>0.05).Conclusion:Unilateral or bilateral selective cerebral perfusion is a safe and effective method of brain protection in operation for TAAD;the advantages of bilateral selective cerebral perfusion are short recovery time,low temporary neurological dysfunction rate and short ICU hospitalization time,these are beneficial to early postoperative rehabilitation and improved long-term quality of life.