title: Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery: based on the Japan Adult Cardiovascular Surgery Database : the Japan Cardiovascular Surgery Database Organization.
abstract: OBJECTIVE
  Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two major types of brain protection for aortic arch surgery. A large-scale clinical study of RCP and ACP is important to clarify the respective characteristics for major adverse events. We conducted a comparative study to evaluate up-to-date clinical outcomes in Japan based on the Japan Adult Cardiovascular Surgery Database (JACVSD).
  
  
  METHODS
  The subjects were confined to cases undergone electively with ACP or RCP for nondissection aneurysms in the ascending aorta and aortic arch between 2005 and 2008 from 13 467 aortic surgeries. There were 2209 ACP cases and 583 RCP cases. A risk-adjusted comparison based on 30-day mortality, operative mortality, and major morbidity was assessed by a multivariable logistic regression analysis. A conditional logistic regression analysis was also conducted in 499 propensity matched-pairs with ACP and RCP.
  
  
  RESULTS
  A risk-adjusted analysis showed no significant differences between the ACP and RCP groups regarding 30-day mortality (3.5% vs. 2.6%), operative mortality (5.3% vs. 4.1%), or stroke (6.8% vs. 3.1%). Propensity-matched pairs also revealed no significant differences between ACP and RCP regarding 30-day mortality (3.4% vs. 2.4%), operative mortality (3.8% vs. 3.4%), or stroke rate (5.0% vs. 3.0%); however, RCP resulted in a significantly higher rate of transient neurological dysfunction (3.0% vs. 5.8%) and need for dialysis (1.6% vs. 4.2%).
  
  
  CONCLUSIONS
  Both RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates. RCP resulted in a higher incidence only in patients demonstrating transient neurological dysfunction and the need for dialysis.
authors.affiliation: Department of Cardiac Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Aichi, Japan. ausui@med.nagoya-u.ac.jp
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Miyata
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
authors.forename: Noboru
authors.initials: N
authors.lastname: Motomura
authors.forename: Shinichi
authors.initials: S
authors.lastname: Takamoto
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D001018:Aortic Diseases / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D016009:Chi-Square Distribution; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007564:Japan; D007674:Kidney Diseases / Q000209:etiology / Q000628:therapy; D016015:Logistic Models; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D057216:Propensity Score; D006435:Renal Dialysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012955:Societies, Medical; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality