Comparative Study of Antegrade Versus Retrograde Cerebral Perfusion in Acute Type A Aortic Dissection: A Prospective Study

Yusuf Shieba

Status: Completed

Conditions: Acute Type A Aortic Dissection

Treatments: Procedure: Retrograde Cerebral Perfusion via Superior Vena Cava; Procedure: Antegrade Cerebral Perfusion via Axillary Artery

Study type: Interventional

Funder types: Other

Identifiers

NCT06870513

SCU-FOM-CTS-2020-4222

Details and patient eligibility

About

This prospective study investigated the comparison of effectiveness of antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) in providing cerebral protection during the surgical treatment of acute Type A aortic dissection (TAAD). Acute type A aortic dissection presents an aortic tear at its ascending portion, posing considerable risk with high morbidity and mortality incidence, especially from neurological insults.

In total, 116 patients with acute type A aortic dissection were randomly assigned to undergo surgical intervention with either ACP through axillary artery cannulation or RCP through superior vena cava cannula placed during deep hypothermic circulatory arrest. Primary objectives focused on measuring and comparing the postoperative neurological complication rates associated with transient neurological deficits (TND) and permanent neurological deficits (PND). Secondary outcomes of interest included the duration of mechanical ventilation, length of stay in the ICU and hospital, and mortality.

Enrollment: 116 patients

Sex: All

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patients diagnosed with acute type A aortic dissection (TAAD).

Exclusion criteria

• Hemodynamic instability.
• Known ischemic heart disease (IHD).
• History of cerebrovascular stroke.
• Heart failure.
• Renal or hepatic impairment.
• Rheumatic heart disease.
• Previous history of radiotherapy.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

116 participants in 2 patient groups

Antegrade cerebral perfusion (ACP)

Experimental group

Description:

Participants underwent surgical repair of acute Type A aortic dissection utilizing antegrade cerebral perfusion. The procedure involved right axillary artery cannulation through an interposition conduit graft (7-mm Dacron tube) for cardiopulmonary bypass and cerebral perfusion during deep hypothermic circulatory arrest (DHCA).

Treatment:

Procedure: Antegrade Cerebral Perfusion via Axillary Artery

Retrograde Cerebral Perfusion (RCP)

Active Comparator group

Description:

Participants in this arm underwent surgical repair of acute Type A aortic dissection utilizing retrograde cerebral perfusion (RCP). Perfusion was provided retrogradely via superior vena cava (SVC) cannulation during deep hypothermic circulatory arrest (DHCA).

Treatment:

Procedure: Retrograde Cerebral Perfusion via Superior Vena Cava