title: Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch surgery: a meta-analysis and systematic review of 5060 patients.
abstract: OBJECTIVE
  Our objective was to determine if antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) combined with deep hypothermia circulatory arrest in aortic arch surgery results in different mortality and neurologic outcomes.
  
  
  METHODS
  The Cochrane Library, Medline, EMBASE, CINAHL, Web of Science, and the Chinese Biomedical Database were searched for studies reporting on postoperative strokes, permanent neurologic dysfunction, temporary neurologic dysfunction, and all causes mortality within 30 days postoperation in aortic arch surgery. Meta-analysis for effect size, t test, and I(2) for detecting heterogeneity and sensitivity analysis for assessing the relative influence of each study was performed.
  
  
  RESULTS
  Fifteen included studies encompassed a total of 5060 patients of whom 2855 were treated with deep hypothermic circulatory arrest plus ACP and 1897 were treated with deep hypothermic circulatory arrest plus RCP. Pooled analysis showed no significant statistical difference (P > .01) of 30-day mortality, permanent neurologic dysfunction, and transient neurologic dysfunction in the 2 groups. Before sensitivity analysis, postoperative stroke incidence in the ACP group was higher than in the RCP group (7.2% vs 4.7%; P < .01). After a study that included a different percentage of patients with a history of central neurologic events in the 2 groups was ruled out, postoperative stroke incidence in the 2 groups also showed no significant statistical difference (P > .01).
  
  
  CONCLUSIONS
  ACP and RCP provide similar cerebral protective effectiveness combined with deep hypothermia circulatory arrest and could be selected according to the actual condition in aortic arch surgery. A high-quality randomized controlled trial is urgently needed to confirm this conclusion, especially for stroke morbidity following ACP or RCP.
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China.
authors: Zhipeng
authors: Z
authors: Hu
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China. Electronic address: wangzhiwp@gmail.com.
authors: Zhiwei
authors: Z
authors: Wang
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China.
authors: Zongli
authors: Z
authors: Ren
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China.
authors: Hongbing
authors: H
authors: Wu
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China.
authors: Min
authors: M
authors: Zhang
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China.
authors: Hao
authors: H
authors: Zhang
authors: Department of Cardiothoracic Surgery, Renmin Hospital of Wuhan University, Hubei Province, Wuhan, China.
authors: Xiaoping
authors: X
authors: Hu
mesh_terms: D001013:Aorta, Thoracic / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D016017:Odds Ratio; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality