A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion

David H Tian; Benjamin Wan; Paul G Bannon; Martin Misfeld; Scott A. LeMaire; Teruhisa Kazui; Nicholas T. Kouchoukos; John A. Elefteriades; Joseph E. Bavaria; Joseph S Coselli; Randall B. Griepp; Friedrich Wilhelm Mohr; Aung Oo; Lars G Svensson; G. Chad Hughes; Malcolm J. Underwood; Edward P. Chen; Thoralf M. Sundt; Tristan D Yan

doi:10.3978/j.issn.2225-319X.2013.05.11

A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion

David H Tian, Benjamin Wan, Paul G Bannon, Martin Misfeld, Scott A. LeMaire, Teruhisa Kazui, Nicholas T. Kouchoukos, John A. Elefteriades, Joseph E. Bavaria, Joseph S Coselli, Randall B. Griepp, Friedrich Wilhelm Mohr, Aung Oo, Lars G Svensson, G. Chad Hughes, Malcolm J. Underwood, Edward P. Chen, Thoralf M. Sundt, Tristan D Yan

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: Recognizing the importance of neuroprotection in aortic arch surgery, deep hypothermic circulatory arrest (DHCA) now underpins operative practice as it minimizes cerebral metabolic activity. When prolonged periods of circulatory arrest are required, selective antegrade cerebral perfusion (SACP) is supplemented as an adjunct. However, concerns exist over the risks of SACP in introducing embolism and hypo- and hyper-perfusing the brain. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA alone or DHCA + SACP as neuroprotection strategies.

METHODS: Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA alone with DHCA + SACP. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.

RESULTS: Nine comparative studies were identified in the present meta-analysis, with 648 patients employing DHCA alone and 370 utilizing DHCA + SACP. No significant differences in temporary or permanent neurological outcomes were identified. DHCA + SACP was associated with significantly better survival outcomes (P=0.008, I(2)=0%), despite longer cardiopulmonary bypass time. Infrequent and inconsistent reporting of other clinical results precluded analysis of systemic outcomes.

CONCLUSIONS: The present meta-analysis indicate the superiority of DHCA + SACP in terms of mortality outcomes.

Original language	English
Pages (from-to)	261-70
Number of pages	10
Journal	Annals of Cardiothoracic Surgery
Volume	2
Issue number	3
DOIs	https://doi.org/10.3978/j.issn.2225-319X.2013.05.11
Publication status	Published - May 2013
Externally published	Yes

Keywords

Deep hypothermic circulatory arrest
antegrade cerebral perfusion
aortic arch surgery
meta-analysis

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10.3978/j.issn.2225-319X.2013.05.11

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Tian, D. H., Wan, B., Bannon, P. G., Misfeld, M., LeMaire, S. A., Kazui, T., Kouchoukos, N. T., Elefteriades, J. A., Bavaria, J. E., Coselli, J. S., Griepp, R. B., Mohr, F. W., Oo, A., Svensson, L. G., Hughes, G. C., Underwood, M. J., Chen, E. P., Sundt, T. M., & Yan, T. D. (2013). A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion. Annals of Cardiothoracic Surgery, 2(3), 261-70. https://doi.org/10.3978/j.issn.2225-319X.2013.05.11

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title = "A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion",

abstract = "INTRODUCTION: Recognizing the importance of neuroprotection in aortic arch surgery, deep hypothermic circulatory arrest (DHCA) now underpins operative practice as it minimizes cerebral metabolic activity. When prolonged periods of circulatory arrest are required, selective antegrade cerebral perfusion (SACP) is supplemented as an adjunct. However, concerns exist over the risks of SACP in introducing embolism and hypo- and hyper-perfusing the brain. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA alone or DHCA + SACP as neuroprotection strategies.METHODS: Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA alone with DHCA + SACP. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.RESULTS: Nine comparative studies were identified in the present meta-analysis, with 648 patients employing DHCA alone and 370 utilizing DHCA + SACP. No significant differences in temporary or permanent neurological outcomes were identified. DHCA + SACP was associated with significantly better survival outcomes (P=0.008, I(2)=0%), despite longer cardiopulmonary bypass time. Infrequent and inconsistent reporting of other clinical results precluded analysis of systemic outcomes.CONCLUSIONS: The present meta-analysis indicate the superiority of DHCA + SACP in terms of mortality outcomes.",

keywords = "Deep hypothermic circulatory arrest, antegrade cerebral perfusion, aortic arch surgery, meta-analysis",

author = "Tian, {David H} and Benjamin Wan and Bannon, {Paul G} and Martin Misfeld and LeMaire, {Scott A.} and Teruhisa Kazui and Kouchoukos, {Nicholas T.} and Elefteriades, {John A.} and Bavaria, {Joseph E.} and Coselli, {Joseph S} and Griepp, {Randall B.} and Mohr, {Friedrich Wilhelm} and Aung Oo and Svensson, {Lars G} and Hughes, {G. Chad} and Underwood, {Malcolm J.} and Chen, {Edward P.} and Sundt, {Thoralf M.} and Yan, {Tristan D}",

year = "2013",

month = may,

doi = "10.3978/j.issn.2225-319X.2013.05.11",

language = "English",

volume = "2",

pages = "261--70",

journal = "Annals of Cardiothoracic Surgery",

issn = "2225-319X",

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Tian, DH, Wan, B, Bannon, PG, Misfeld, M, LeMaire, SA, Kazui, T, Kouchoukos, NT, Elefteriades, JA, Bavaria, JE, Coselli, JS, Griepp, RB, Mohr, FW, Oo, A, Svensson, LG, Hughes, GC, Underwood, MJ, Chen, EP, Sundt, TM & Yan, TD 2013, 'A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion', Annals of Cardiothoracic Surgery, vol. 2, no. 3, pp. 261-70. https://doi.org/10.3978/j.issn.2225-319X.2013.05.11

TY - JOUR

T1 - A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion

AU - Tian, David H

AU - Wan, Benjamin

AU - Bannon, Paul G

AU - Misfeld, Martin

AU - LeMaire, Scott A.

AU - Kazui, Teruhisa

AU - Kouchoukos, Nicholas T.

AU - Elefteriades, John A.

AU - Bavaria, Joseph E.

AU - Coselli, Joseph S

AU - Griepp, Randall B.

AU - Mohr, Friedrich Wilhelm

AU - Oo, Aung

AU - Svensson, Lars G

AU - Hughes, G. Chad

AU - Underwood, Malcolm J.

AU - Chen, Edward P.

AU - Sundt, Thoralf M.

AU - Yan, Tristan D

PY - 2013/5

Y1 - 2013/5

N2 - INTRODUCTION: Recognizing the importance of neuroprotection in aortic arch surgery, deep hypothermic circulatory arrest (DHCA) now underpins operative practice as it minimizes cerebral metabolic activity. When prolonged periods of circulatory arrest are required, selective antegrade cerebral perfusion (SACP) is supplemented as an adjunct. However, concerns exist over the risks of SACP in introducing embolism and hypo- and hyper-perfusing the brain. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA alone or DHCA + SACP as neuroprotection strategies.METHODS: Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA alone with DHCA + SACP. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.RESULTS: Nine comparative studies were identified in the present meta-analysis, with 648 patients employing DHCA alone and 370 utilizing DHCA + SACP. No significant differences in temporary or permanent neurological outcomes were identified. DHCA + SACP was associated with significantly better survival outcomes (P=0.008, I(2)=0%), despite longer cardiopulmonary bypass time. Infrequent and inconsistent reporting of other clinical results precluded analysis of systemic outcomes.CONCLUSIONS: The present meta-analysis indicate the superiority of DHCA + SACP in terms of mortality outcomes.

AB - INTRODUCTION: Recognizing the importance of neuroprotection in aortic arch surgery, deep hypothermic circulatory arrest (DHCA) now underpins operative practice as it minimizes cerebral metabolic activity. When prolonged periods of circulatory arrest are required, selective antegrade cerebral perfusion (SACP) is supplemented as an adjunct. However, concerns exist over the risks of SACP in introducing embolism and hypo- and hyper-perfusing the brain. The present meta-analysis aims to compare postoperative outcomes in arch surgery using DHCA alone or DHCA + SACP as neuroprotection strategies.METHODS: Electronic searches were performed using six databases from their inception to January 2013. Two reviewers independently identified all relevant studies comparing DHCA alone with DHCA + SACP. Data were extracted and meta-analyzed according to pre-defined clinical endpoints.RESULTS: Nine comparative studies were identified in the present meta-analysis, with 648 patients employing DHCA alone and 370 utilizing DHCA + SACP. No significant differences in temporary or permanent neurological outcomes were identified. DHCA + SACP was associated with significantly better survival outcomes (P=0.008, I(2)=0%), despite longer cardiopulmonary bypass time. Infrequent and inconsistent reporting of other clinical results precluded analysis of systemic outcomes.CONCLUSIONS: The present meta-analysis indicate the superiority of DHCA + SACP in terms of mortality outcomes.

KW - Deep hypothermic circulatory arrest

KW - antegrade cerebral perfusion

KW - aortic arch surgery

KW - meta-analysis

U2 - 10.3978/j.issn.2225-319X.2013.05.11

DO - 10.3978/j.issn.2225-319X.2013.05.11

M3 - Article

C2 - 23977593

SN - 2225-319X

VL - 2

SP - 261

EP - 270

JO - Annals of Cardiothoracic Surgery

JF - Annals of Cardiothoracic Surgery

IS - 3

ER -

A meta-analysis of deep hypothermic circulatory arrest alone versus with adjunctive selective antegrade cerebral perfusion

Abstract

Keywords

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