title: Bilateral versus unilateral antegrade cerebral perfusion in arch reconstruction for aortic dissection.
abstract: BACKGROUND
  The superiority of bilateral versus unilateral antegrade cerebral perfusion (ACP) has been the subject of much debate. This study aimed to compare the two methods of cerebral perfusion.
  
  
  METHODS
  Between September 2005 and June 2011, 263 patients (median age 51.4±10.1 years, range, 26 to 75; 200 men) underwent open aortic arch reconstruction with hypothermic circulatory arrest and bilateral or unilateral ACP. Among them, 231 patients had acute aortic dissection, 12 had subacute aortic dissection, 20 had chronic aortic dissection, 7 had Marfan syndrome, 8 had reconstruction secondary to endovascular stent graft placement for type B dissection, and 9 had bicuspid aortic valve. Our patient cohort is divided into those protected with hypothermic circulatory arrest and bilateral ACP (group A, n=128) and those with hypothermic circulatory arrest and unilateral ACP (group B, n=135).
  
  
  RESULTS
  There was no significant difference between groups A and B in cardiopulmonary bypass time, cross-clamp time, or cerebral perfusion time. Overall in-hospital mortality was 11.7% for group A and 11.1% for group B (p=0.877). Postoperative temporary and permanent neurologic dysfunction was 5.5% versus 6.7% and 12.5% versus 10.4%, respectively (group A versus group B: p=0.685, p=0.587). Intensive care unit time was 9.4±9.8 days for group A and 8.4±14.0 days for group B (p=0.972). Hospitalization was 24.3±14.6 days for group A and 23.1±21.1 days for group B (p=0.172).
  
  
  CONCLUSIONS
  Unilateral ACP with hypothermic circulatory arrest is a safe cerebral protection technique for open aortic arch reconstruction, and is not inferior to bilateral ACP with hypothermic circulatory arrest.
authors.affiliation: Shanghai Institute of Cardiovascular Disease, Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Shuyang
authors.initials: S
authors.lastname: Lu
authors.forename: Xiaoning
authors.initials: X
authors.lastname: Sun
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.forename: Shouguo
authors.initials: S
authors.lastname: Yang
authors.forename: Kai
authors.initials: K
authors.lastname: Song
authors.forename: Hao
authors.initials: H
authors.lastname: Lai
authors.forename: Kejian
authors.initials: K
authors.lastname: Hu
authors.forename: Chunsheng
authors.initials: C
authors.lastname: Wang
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012039:Regional Blood Flow / Q000502:physiology; D016019:Survival Analysis