Original articleAdult cardiacUnilateral Versus Bilateral Antegrade Cerebral Protection During Aortic Surgery: An Updated Meta-Analysis
Section snippets
Patients and Methods
To date, about the topic of unilateral versus bilateral ASCP, there have been published 3 completely new papers 7, 8, 9 and 2 previously published series 10, 11 have been updated with larger sample sizes and comparative analysis. These resulted in the inclusion of more than 1,600 completely new patient data in the analysis. Present systematic review and meta-analysis were done with the use of the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines [12]; search strategy and
Results
Finally, 32 publications (see Table 1 for references) reporting on 6,788 patients were included in the analysis. Of those, 3,723 patients received bilateral ASCP and 3,065 patients received unilateral ASCP. Baseline characteristics of the 2 treatment groups are depicted in Table 2.
Pooled analysis showed similar rates of postoperative mortality: 9.8% (95% CI, 7.8% to 12.3%) for bilateral ASCP versus 7.6% (95% CI, 5.7% to 10.2%) for unilateral ASCP, p = 0.19 (Fig 1). As the latter, postoperative
Comment
This updated meta-analysis confirmed the previous finding of similar postoperative rates of mortality and PND between patients in whom cerebral protection was administered by means of unilateral or bilateral ASCP in association with different degrees of hypothermia [6]. According to past findings 4, 6, moderate hypothermia has been found to be associated with best outcomes. Moreover, as already known, advanced age, non-elective indication to surgery, longer operative times, and lower
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2021, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :For example, in cases of suspected hypoperfusion, cerebral perfusion may be improved by increasing mean arterial blood pressure and hemoglobin levels and by reducing the cerebral metabolic rate. Even though many techniques for intraoperative neuromonitoring exist, such as electroencephalography, evoked potential measurements, and transcranial Doppler, near-infrared spectroscopy often is used in aortic reconstruction to monitor and optimize cerebral oxygenation during hypothermic circulatory arrest with cerebral perfusion adjuncts.35-38 In conclusion, this case highlighted the challenges in the diagnosis and management of intraoperative acute aortic dissection during cardiac surgery.