title: Antegrade versus retrograde cerebral protection in repair of acute ascending aortic dissection.
abstract: The objective of this study was to compare retrograde with antegrade cerebral protection during acute aortic dissection repair using cerebral oximetry measurements. Fifty consecutive acute ascending aortic dissection repairs were analyzed. Cerebral oximetry data were collected for 41  of 50. Eight patients who had antegrade cerebral protection alone and 29 of 41 had retrograde cerebral protection alone. The per cent change in cerebral oximetry values during deep hypothermic circulatory arrest from baseline and from prearrest values was compared for the two groups using  Student t test. The per cent change from baseline for the antegrade patients was: right 13.8 per cent and left -2.5 per cent; the per cent change from baseline for retrograde patients was: right 0.8 per cent and left 0.2 per cent (P values 0.216 and 0.725, respectively).  The per cent change from the prearrest value for the antegrade patients was: right -12 per cent and left -15 per cent; the per cent change from prearrest for retrograde patients was: right -15 per cent and left -16 per cent (P values 0.514 and 0.956, respectively).  No compelling evidence for an advantage to either antegrade or retrograde cerebral perfusion was detected. Further study with a focus on neurologic outcomes is warranted.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky, USA. jtrivedi@louisvilleheartsurgery.com
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Williams
authors.forename: Brian L
authors.initials: BL
authors.lastname: Ganzel
authors.forename: A David
authors.initials: AD
authors.lastname: Slater
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.forename: Jaimin R
authors.initials: JR
authors.lastname: Trivedi
authors.forename: Harvey L
authors.initials: HL
authors.lastname: Edmonds
authors.forename: Sebastian A
authors.initials: SA
authors.lastname: Pagni
mesh_terms: D000784:Aortic Dissection / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000097:blood / Q000453:epidemiology / Q000601:surgery*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D015897:Comorbidity; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010092:Oximetry; D015424:Reperfusion / Q000379:methods; D020521:Stroke / Q000453:epidemiology / Q000517:prevention & control*