Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery: Based on the Japan adult cardiovascular surgery database: The Japan cardiovascular surgery database organization

Akihiko Usui, Hiroaki Miyata, Yuichi Ueda, Noboru Motomura, Shinichi Takamoto

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Purpose. Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two major types of brain protection for aortic arch surgery. A large-scale clinical study of RCP and ACP is important to clarify the respective characteristics for major adverse events. We conducted a comparative study to evaluate up-todate clinical outcomes in Japan based on the Japan Adult Cardiovascular Surgery Database (JACVSD). Methods. The subjects were confined to cases undergone electively with ACP or RCP for nondissection aneurysms in the ascending aorta and aortic arch between 2005 and 2008 from 13 467 aortic surgeries. There were 2209 ACP cases and 583 RCP cases. A risk-adjusted comparison based on 30-day mortality, operative mortality, and major morbidity was assessed by a multivariable logistic regression analysis. A conditional logistic regression analysis was also conducted in 499 propensity matched-pairs with ACP and RCP. Results. A risk-adjusted analysis showed no significant differences between the ACP and RCP groups regarding 30-day mortality (3.5% vs. 2.6%), operative mortality (5.3% vs. 4.1%), or stroke (6.8% vs. 3.1%). Propensity matched pairs also revealed no significant differences between ACP and RCP regarding 30-day mortality (3.4% vs. 2.4%), operative mortality (3.8% vs. 3.4%), or stroke rate (5.0% vs. 3.0%); however, RCP resulted in a significantly higher rate of transient neurological dysfunction (3.0% vs. 5.8%) and need for dialysis (1.6% vs. 4.2%). Conclusion. Both RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates. RCP resulted in a higher incidence only in patients demonstrating transient neurological dysfunction and the need for dialysis.

Original languageEnglish
Pages (from-to)132-139
Number of pages8
JournalGeneral Thoracic and Cardiovascular Surgery
Volume60
Issue number3
DOIs
Publication statusPublished - 2012 Mar
Externally publishedYes

Fingerprint

Thoracic Aorta
Japan
Perfusion
Organizations
Databases
Mortality
Stroke
Dialysis
Logistic Models
Regression Analysis

Keywords

  • Aortic surgery
  • Brain protection
  • Database
  • Mortality
  • Stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

@article{c87970d01f06454780b38186cc6c5ea3,
title = "Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery: Based on the Japan adult cardiovascular surgery database: The Japan cardiovascular surgery database organization",
abstract = "Purpose. Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two major types of brain protection for aortic arch surgery. A large-scale clinical study of RCP and ACP is important to clarify the respective characteristics for major adverse events. We conducted a comparative study to evaluate up-todate clinical outcomes in Japan based on the Japan Adult Cardiovascular Surgery Database (JACVSD). Methods. The subjects were confined to cases undergone electively with ACP or RCP for nondissection aneurysms in the ascending aorta and aortic arch between 2005 and 2008 from 13 467 aortic surgeries. There were 2209 ACP cases and 583 RCP cases. A risk-adjusted comparison based on 30-day mortality, operative mortality, and major morbidity was assessed by a multivariable logistic regression analysis. A conditional logistic regression analysis was also conducted in 499 propensity matched-pairs with ACP and RCP. Results. A risk-adjusted analysis showed no significant differences between the ACP and RCP groups regarding 30-day mortality (3.5{\%} vs. 2.6{\%}), operative mortality (5.3{\%} vs. 4.1{\%}), or stroke (6.8{\%} vs. 3.1{\%}). Propensity matched pairs also revealed no significant differences between ACP and RCP regarding 30-day mortality (3.4{\%} vs. 2.4{\%}), operative mortality (3.8{\%} vs. 3.4{\%}), or stroke rate (5.0{\%} vs. 3.0{\%}); however, RCP resulted in a significantly higher rate of transient neurological dysfunction (3.0{\%} vs. 5.8{\%}) and need for dialysis (1.6{\%} vs. 4.2{\%}). Conclusion. Both RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates. RCP resulted in a higher incidence only in patients demonstrating transient neurological dysfunction and the need for dialysis.",
keywords = "Aortic surgery, Brain protection, Database, Mortality, Stroke",
author = "Akihiko Usui and Hiroaki Miyata and Yuichi Ueda and Noboru Motomura and Shinichi Takamoto",
year = "2012",
month = "3",
doi = "10.1007/s11748-011-0857-2",
language = "English",
volume = "60",
pages = "132--139",
journal = "General Thoracic and Cardiovascular Surgery",
issn = "1863-6705",
publisher = "Springer Japan",
number = "3",

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TY - JOUR

T1 - Risk-adjusted and case-matched comparative study between antegrade and retrograde cerebral perfusion during aortic arch surgery

T2 - Based on the Japan adult cardiovascular surgery database: The Japan cardiovascular surgery database organization

AU - Usui, Akihiko

AU - Miyata, Hiroaki

AU - Ueda, Yuichi

AU - Motomura, Noboru

AU - Takamoto, Shinichi

PY - 2012/3

Y1 - 2012/3

N2 - Purpose. Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two major types of brain protection for aortic arch surgery. A large-scale clinical study of RCP and ACP is important to clarify the respective characteristics for major adverse events. We conducted a comparative study to evaluate up-todate clinical outcomes in Japan based on the Japan Adult Cardiovascular Surgery Database (JACVSD). Methods. The subjects were confined to cases undergone electively with ACP or RCP for nondissection aneurysms in the ascending aorta and aortic arch between 2005 and 2008 from 13 467 aortic surgeries. There were 2209 ACP cases and 583 RCP cases. A risk-adjusted comparison based on 30-day mortality, operative mortality, and major morbidity was assessed by a multivariable logistic regression analysis. A conditional logistic regression analysis was also conducted in 499 propensity matched-pairs with ACP and RCP. Results. A risk-adjusted analysis showed no significant differences between the ACP and RCP groups regarding 30-day mortality (3.5% vs. 2.6%), operative mortality (5.3% vs. 4.1%), or stroke (6.8% vs. 3.1%). Propensity matched pairs also revealed no significant differences between ACP and RCP regarding 30-day mortality (3.4% vs. 2.4%), operative mortality (3.8% vs. 3.4%), or stroke rate (5.0% vs. 3.0%); however, RCP resulted in a significantly higher rate of transient neurological dysfunction (3.0% vs. 5.8%) and need for dialysis (1.6% vs. 4.2%). Conclusion. Both RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates. RCP resulted in a higher incidence only in patients demonstrating transient neurological dysfunction and the need for dialysis.

AB - Purpose. Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two major types of brain protection for aortic arch surgery. A large-scale clinical study of RCP and ACP is important to clarify the respective characteristics for major adverse events. We conducted a comparative study to evaluate up-todate clinical outcomes in Japan based on the Japan Adult Cardiovascular Surgery Database (JACVSD). Methods. The subjects were confined to cases undergone electively with ACP or RCP for nondissection aneurysms in the ascending aorta and aortic arch between 2005 and 2008 from 13 467 aortic surgeries. There were 2209 ACP cases and 583 RCP cases. A risk-adjusted comparison based on 30-day mortality, operative mortality, and major morbidity was assessed by a multivariable logistic regression analysis. A conditional logistic regression analysis was also conducted in 499 propensity matched-pairs with ACP and RCP. Results. A risk-adjusted analysis showed no significant differences between the ACP and RCP groups regarding 30-day mortality (3.5% vs. 2.6%), operative mortality (5.3% vs. 4.1%), or stroke (6.8% vs. 3.1%). Propensity matched pairs also revealed no significant differences between ACP and RCP regarding 30-day mortality (3.4% vs. 2.4%), operative mortality (3.8% vs. 3.4%), or stroke rate (5.0% vs. 3.0%); however, RCP resulted in a significantly higher rate of transient neurological dysfunction (3.0% vs. 5.8%) and need for dialysis (1.6% vs. 4.2%). Conclusion. Both RCP and ACP provide comparable clinical outcomes regarding both the mortality and stroke rates. RCP resulted in a higher incidence only in patients demonstrating transient neurological dysfunction and the need for dialysis.

KW - Aortic surgery

KW - Brain protection

KW - Database

KW - Mortality

KW - Stroke

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U2 - 10.1007/s11748-011-0857-2

DO - 10.1007/s11748-011-0857-2

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