- 作者：Emiliano Angeloni ; Umberto Benedetto ; Johanna J.M. Takkenberg ; Ivan Stigliano ; Antonino Roscitano ; Giovanni Melina ; Riccardo Sinatra
- 关键词：ACP ; antegrade cerebral perfusion ; b-ACP ; bilateral antegrade cerebral perfusion ; CA ; circulatory arrest ; CI ; confidence interval ; PND ; permanent neurologic dysfunction ; TND ; temporary neurologic dysfunction ; u-ACP ; unilateral antegrade cerebral perfusion
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：January, 2014
- 年：2014
- 卷：147
- 期：1
- 页码：60-67
- 全文大小：795 K
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聽=聽.78), PND (6.1% vs 6.5%; P聽=聽.80), and TND (7.1% vs 8.8%; P聽=聽.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聽PND and TND rates after circulatory arrest for complex aortic surgery.