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Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study
OBJECTIVES: Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with re...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056667/ https://www.ncbi.nlm.nih.gov/pubmed/33879045 http://dx.doi.org/10.1186/s12872-021-02002-9 |
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author | Lin, Jing Qin, Zhen Liu, Xinhao Xiong, Jiyue Wu, Zhong Guo, Yingqiang Kang, Deying Du, Lei |
author_facet | Lin, Jing Qin, Zhen Liu, Xinhao Xiong, Jiyue Wu, Zhong Guo, Yingqiang Kang, Deying Du, Lei |
author_sort | Lin, Jing |
collection | PubMed |
description | OBJECTIVES: Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes. METHODS: This pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products. RESULTS: A total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21–1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10–0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group. CONCLUSIONS: RIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications. Trial registration: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-021-02002-9. |
format | Online Article Text |
id | pubmed-8056667 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-80566672021-04-20 Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study Lin, Jing Qin, Zhen Liu, Xinhao Xiong, Jiyue Wu, Zhong Guo, Yingqiang Kang, Deying Du, Lei BMC Cardiovasc Disord Research Article OBJECTIVES: Antegrade cerebral perfusion (ACP) under moderate hypothermic circulatory arrest is used during total aortic arch replacement surgery (TARS) in patients with acute type A aortic dissection, but it is associated with high mortality and morbidity. We hypothesized that combining ACP with retrograde inferior vena caval perfusion (RIVP) improves outcomes. METHODS: This pilot study was prospective, randomized, controlled and assessor-blinded. Patients scheduled for TARS were randomly treated with either ACP or RIVP + ACP. The primary outcome was a composite of mortality and major complications including paraplegia, postoperative renal failure, severe liver dysfunction, and gastrointestinal complications. Secondary outcomes included neurological complications, length of intubation and requirement of blood products. RESULTS: A total of 76 patients were recruited (n = 38 per group). Primary outcome occurred in 23 patients (61%) in the ACP group and 16 (42%) in the RIVP + ACP group (OR: 0.60, 95% CI: 0.21–1.62; p = 0.31). There was a lower incidence of transient neurological deficits in the RIVP + ACP group (26% vs. 58%, OR: 0.26; 95% CI: 0.10–0.67,p = 0.006;). The RIVP + ACP group underwent shorter intubation (25 vs 47 h, p = 0.022) and required fewer blood products (red cells, 3.8 units vs 6.5 units, p = 0.047; platelet: 2.0 units vs 2.0 units, p = 0.023) compared with the ACP group. CONCLUSIONS: RIVP + ACP may be associated with lower incidence of transient neurological deficits, shorter intubation and less blood transfusion requirement than ACP alone during TARS. Multi-center, randomized trials with larger samples are required to determine whether RIVP + ACP is associated with lower rates of mortality and major complications. Trial registration: Pilot study of a RCT registered in clinicaltrials.gov (NCT03607786), Registered 30 July, 2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03607786. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-021-02002-9. BioMed Central 2021-04-20 /pmc/articles/PMC8056667/ /pubmed/33879045 http://dx.doi.org/10.1186/s12872-021-02002-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
spellingShingle | Research Article Lin, Jing Qin, Zhen Liu, Xinhao Xiong, Jiyue Wu, Zhong Guo, Yingqiang Kang, Deying Du, Lei Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
title | Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
title_full | Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
title_fullStr | Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
title_full_unstemmed | Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
title_short | Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
title_sort | retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8056667/ https://www.ncbi.nlm.nih.gov/pubmed/33879045 http://dx.doi.org/10.1186/s12872-021-02002-9 |
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