title: Unilateral versus bilateral antegrade cerebral protection during circulatory arrest in aortic surgery: a meta-analysis of 5100 patients.
abstract: OBJECTIVE
  Our objective was to determine whether the use of unilateral (u-ACP) or bilateral antegrade cerebral perfusion (b-ACP) results in different mortality and neurologic outcomes after complex aortic surgery.
  
  
  METHODS
  PubMed, Embase, and the Cochrane Library were searched for studies reporting on postoperative mortality and permanent (PND) and temporary neurologic dysfunction (TND) in complex aortic surgery requiring circulatory arrest with antegrade cerebral protection. Analysis of heterogeneity was performed with the Cochrane Q statistic.
  
  
  RESULTS
  Twenty-eight studies were analyzed for a total of 1894 patients receiving u-ACP versus 3206 receiving b-ACP. Pooled analysis showed similar rates of 30-day mortality (8.6% vs 9.2% for u-ACP and b-ACP, respectively; P = .78), PND (6.1% vs 6.5%; P = .80), and TND (7.1% vs 8.8%; P = .46). Age, sex, and cardiopulmonary bypass time did not influence effect size estimates. Higher rates of postoperative mortality and PND were among nonelective operations and for highest temperatures and duration of the circulatory arrest. The Egger test excluded publication bias for the outcomes investigated.
  
  
  CONCLUSIONS
  This meta-analysis shows that b-ACP and u-ACP have similar postoperative mortality and both PND and TND rates after circulatory arrest for complex aortic surgery.
authors.affiliation: Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy. Electronic address: emilianoangeloni@gmail.com.
authors.forename: Emiliano
authors.initials: E
authors.lastname: Angeloni
authors.affiliation: Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Benedetto
authors.affiliation: Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
authors.forename: Johanna J M
authors.initials: JJ
authors.lastname: Takkenberg
authors.affiliation: Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy.
authors.forename: Ivan
authors.initials: I
authors.lastname: Stigliano
authors.affiliation: Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Roscitano
authors.affiliation: Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Melina
authors.affiliation: Department of Cardiac Surgery, Sapienza, Università di Roma, Policlinico Sant'Andrea, Rome, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Sinatra
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: 19; 26; 26.1; ACP; CA; CI; PND; TND; antegrade cerebral perfusion; b-ACP; bilateral antegrade cerebral perfusion; circulatory arrest; confidence interval; permanent neurologic dysfunction; temporary neurologic dysfunction; u-ACP; unilateral antegrade cerebral perfusion