Abstract
Objectives: The aim of the study is
to compare the safety and efficacy
of unilateral anterograde cerebral perfusion (UACP) and bilateral
anterograde cerebral perfusion (BACP) for acute type A aortic dissection
(ATAAD).
Methods: A systematic review of the MEDLINE (PubMed), Scopus,
and Cochrane Library databases (last search: August
7th, 2021) was performed according to the PRISMA
statement. Studies directly comparing UACP versus BACP for ATAAD were
included. Random-effects meta-analyses were performed.
Results: Eight retrospective cohort studies were identified,
incorporating 2416 patients (UACP: 843, BACP: 1573). No statistically
significant difference was observed regarding in-hospital mortality
(odds ratio [OR]:1.05 [95% Confidence Interval
(95%CI):0.70-1.57]), permanent neurological deficit (PND) (OR: 0.94
[95%CI:0.52-1.70]), transient neurological deficit (TND) (OR: 1.37
[95%CI:0.98-1.92]), renal failure (OR: 0.96
[95%CI:0.70-1.32]), and re-exploration for bleeding (OR: 0.77
[95%CI:0.48-1.22]). Meta-regression analysis revealed that PND and
TND were not influenced by differences in rates of total arch repair,
Bentall procedure and concomitant CABG in UACP and BACP groups.
Cardiopulmonary bypass time (Standard Mean Difference [SMD]:-0.11
[95%CI:-0.22, 0.44]), Cross clamp time (SMD:-0.04 [95%CI:-0.38,
0.29]) and hypothermic circulatory arrest time (SMD:-0.12
[95%CI:-0.55, 0.30]) were comparable between UACP and BACP.
Intensive care unit stay was shorter in BACP arm (SMD:0.16
[95%CI:0.01, 0.31]), however, length of hospital stay was shorter
in UACP arm (SMD:-0.25 [95%CI:-0.45, -0.06]).
Conclusions: UACP and
BACP had similar results in terms of in-hospital mortality, PND, TND,
renal failure and re-exploration for bleeding rate in patients with
ATAAD. ICU stay was shorter in the BACP arm while LOS was shorter in the
UACP arm.