This retrospective cohort study aims to evaluate the efficacy of a Bilateral Modified Catheter Antegrade Cerebral Perfusion (Modified bACP) technique in acute Type A aortic dissection surgery. Medical records from January 1, 2021, through October 31, 2024, at China Medical University Hospital will be reviewed. The primary outcomes include in-hospital mortality and stroke rate, while secondary outcomes include ICU/hospital stay, mechanical ventilation duration, and other postoperative complications (e.g., acute kidney injury, sepsis, myocardial infarction).
Background and Rationale Acute Type A aortic dissection (ATAAD) is a life-threatening condition requiring urgent surgical repair. Prolonged circulatory arrest increases the risk of neurological complications. Bilateral antegrade cerebral perfusion (bACP) has shown potential to reduce ischemic injury. However, conventional bACP requires additional surgical access. This study examines a Modified bACP approach that may reduce surgical trauma while maintaining adequate cerebral perfusion. Objectives This retrospective cohort study evaluates whether Modified bACP improves postoperative outcomes compared to conventional perfusion strategies in ATAAD surgery at China Medical University Hospital (2021/1/1-2024/10/31). Methods We will collect and analyze medical records of adult patients who underwent ATAAD repair, comparing those who received Modified bACP to those managed with conventional perfusion. Outcome Measures Primary Outcomes: In-hospital mortality 30-day mortality Secondary Outcomes: Hospital length of stay (day) ICU length of stay (day) Mechanical ventilation duration (hours) Need for tracheostomy Stroke Postoperative neurological deficit Paraplegia Coma Atrial fibrillation (Af) Myocardial infarction Acute kidney injury (AKI) Dialysis requirement Reoperation for bleeding Sepsis Significance This study aims to provide comprehensive data on the safety and efficacy of Modified bACP in ATAAD surgery, potentially improving neurological protection and reducing other major complications and resource utilization. The findings may guide clinical practice and inform future protocol developments.
Study Type
OBSERVATIONAL
Enrollment
273
A modified bilateral catheter antegrade cerebral perfusion technique used for acute Type A aortic dissection repair. This approach aims to reduce surgical trauma by avoiding additional right axillary access while maintaining stable cerebral perfusion.
Patients receiving the conventional perfusion strategy for aortic arch surgery, which may include standard bilateral ACP based on the surgeon's preference and the patient's condition.
China Medical University Hospital
Taichung, Taiwan
Stroke
New-onset cerebrovascular accident or imaging-confirmed stroke during hospitalization.
Time frame: Through hospital discharge (on average about 14 days post-surgery)
Postoperative Neurological Deficit
Any persistent neurological deficit (e.g., motor/sensory deficits) identified after surgery.
Time frame: Through hospital discharge (on average about 14 days post-surgery)
30-day Mortality
All-cause mortality occurring within 30 days after the surgical procedure.
Time frame: Assessed at 30 days post-surgery
Hospital Stay (day)
Total number of days from the operation date to the date of hospital discharge.
Time frame: From end of surgery to hospital discharge (up to 21 days).
ICU Stay (day)
Length of stay in the intensive care unit after surgery.
Time frame: From end of surgery to ICU discharge (up to 10 days).
Mechanical Ventilation (hour)
Duration of mechanical ventilation in hours.
Time frame: From end of surgery until extubation (up to 72 hours).
Acute Kidney Injury (AKI)
Acute kidney injury defined by changes in serum creatinine or urine output (e.g., KDIGO criteria).
Time frame: During the index hospitalization (on average about 10-14 days post-surgery)
Dialysis Requirement
Proportion of patients requiring renal replacement therapy (dialysis) postoperatively.
Time frame: During the index hospitalization (on average about 10-14 days post-surgery)
Reoperation for Bleeding
Number of patients requiring a return to the operating room for bleeding control or hematoma.
Time frame: During the index hospitalization (on average about 72 hours post-surgery)
Sepsis
Incidence of sepsis as defined by current guidelines (e.g., Sepsis-3), typically requiring positive cultures and organ dysfunction.
Time frame: During the index hospitalization (on average within 7 days post-surgery)
Atrial Fibrillation (Af)
New-onset atrial fibrillation or documented arrhythmia episodes requiring clinical management.
Time frame: During the index hospitalization (on average within 7 days post-surgery)
Myocardial Infarction
Clinically confirmed myocardial infarction based on ECG changes, cardiac enzymes, and clinical symptoms.
Time frame: During the index hospitalization (on average about 10-14 days post-surgery)
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