Different Modes of Cardiopulmonary Bypass and Cerebral Perfusion for Cerebral Protection in Patients with Stanford Type A Aortic Dissection

Objective To investigate the impact of different modes of cardiopulmonary bypass(CPB)and cerebral perfusion on cerebral protection in patients with Stanford type A aortic dissection(AD).Methods Clinical data of 117 patients with Stanford type A AD who underwent surgical therapy from April 2007 to March 2012 in the First Affiliated Hospital of Harbin Medical University were retrospectively analyzed.All the patients were divided into 3 groups according to different modes of CPB and cerebral perfusion they received.In group 1,45 patients received CPB perfusion through the femoral artery and unilateral or bilateral antegrade selective cerebral perfusion(ASCP)after circulatory arrest.In group 2,38 patients received CPB perfusion through the subclavian artery or innominate artery and unilateral or bilateral ASCP after circulatory arrest.In group 3,34 patients received antegrade and retrograde CPB perfusion through both subclavian artery or innominate artery and femoral artery,and unilateral or bilateral ASCP after circulatory arrest.Postoperative occurrence of transient neurological dysfunction(TND),permanent neurological dysfunction(PND)and influential factors were compared between the 3 groups.Results Incidence of postoperative cerebral complications of group 1 was significantly higher than those of group 2 and 3(37.77% vs.13.16% vs.14.71%,P 0.05).During CPB,cooling time of group 3 was significantly shorter than those of group 1 and 2(35.56±4.35 vs.40.00±5.63 and 39.58±6.03,P 0.05).There was no statistical difference in other influential factors among the 3 groups(P 0.05).Conclusion Antegrade and retrograde CPB perfusion in combination with ASCP has a smooth and quicker cooling rate,may provide better protection for the spinal cord,kidney and intraperitoneal organs and especially decrease the incidence of postoperative cerebral complications,therefore is proved current best method for organ protection.