Impact of Antegrade Selective Cerebral Perfusion Flow Ranges on Clinical and Neurological Outcomes in Aortic Arch Surgery

August 6, 2026 No Comments

This retrospective single-center study evaluated 492 adults undergoing aortic arch surgery with bilateral selective antegrade cerebral perfusion (SACP). Patients were grouped by indexed cerebral perfusion flow (<10, 10–15, or >15 mL/kg/min). No significant differences were found in 30-day mortality, permanent neurological dysfunction, or transient neurological deficits across flow ranges. The findings support individualized intraoperative perfusion management while maintaining recommended flow targets.

The Impact of Re-operation on Aortic Arch Reconstructive Surgery: Evidence from a Multicentre, National Registry

April 1, 2026 No Comments

This multicenter Canadian registry study examined 2,481 patients who underwent aortic arch reconstruction between 2002 and 2021, including 374 redo cases after prior open-heart surgery. Despite a higher comorbidity burden, redo surgery was not associated with significantly higher overall operative mortality or major morbidity than primary surgery. Risk increased with older age, acute dissection or rupture, and longer cardiopulmonary bypass time.

The Impact of Intraoperative Fibrinogen Replacement Therapy on the Clinical Outcome of Surgical Therapy for Type A Acute Aortic Dissection

March 6, 2026 No Comments

This retrospective study evaluated the role of fibrinogen replacement therapy (FRT) using fibrinogen concentrate during emergency surgery for acute type A aortic dissection (ATAAD). Among 87 patients, FRT significantly improved postoperative fibrinogen levels and helped maintain hemostasis without increasing complications. Although intraoperative blood loss was higher in the FRT group due to more severe coagulopathy, postoperative bleeding was similar between groups, suggesting FRT effectively stabilizes coagulation during complex aortic surgery.

Association Between Cardiopulmonary Bypass Weaning Time and Adverse Outcomes in Patients With Aortic Dissection Who Underwent Total Arch Replacement Combined With Stented Elephant Trunk Implantation

February 28, 2026 No Comments

This retrospective single-center study of 475 patients with acute type A aortic dissection undergoing total arch replacement with stented elephant trunk implantation found that prolonged cardiopulmonary bypass (CPB) weaning time was independently associated with increased in-hospital mortality and postoperative stroke. A cutoff of 90 minutes strongly predicted early mortality and reduced short-term survival, though mid-term survival was unaffected.

Neutrophil Percentage to Albumin Ratio Is Associated With In-Hospital Mortality in Patients With Acute Type A Aortic Dissection

June 5, 2025 No Comments

This study found that a higher neutrophil percentage to albumin ratio (NPAR) on hospital admission significantly predicts in-hospital mortality in patients undergoing surgery for acute type A aortic dissection (AAAD). Among 813 patients, higher NPAR levels correlated with increased risk of death, acute kidney injury, and longer ICU stays. NPAR outperformed neutrophils or albumin alone in prognostic value, suggesting it as a valuable, accessible clinical biomarker.

Innominate Artery Graft Cannulation for Selective Antegrade Cerebral Perfusion in Aortic Surgery: Clinical Findings and Feasibility

March 29, 2025 No Comments

This retrospective study evaluates the safety and efficacy of innominate artery (IA) graft cannulation for selective antegrade cerebral perfusion (SACP) in aortic surgery. Analyzing 196 patients, including those with Type A acute aortic dissection and Marfan syndrome, the results showed low rates of stroke (2.04%), mortality (3.06%), and acute renal failure (3.06%). IA graft cannulation emerged as a reliable and efficient technique for cerebral protection during complex aortic procedures.

Relatively Increased CO2 Delivered to the Brain From the Descending Aorta Leading to an Elevated Respiratory Rate Causing Differential Hypocapnia (RIDDLER or East-West Syndrome): New Pitfalls in Awake Peripheral V-A ECMO

March 16, 2025 No Comments

This article describes a newly recognized physiological phenomenon, RIDDLER (East-West Syndrome), in patients on awake peripheral V-A ECMO. It occurs when CO2-rich blood from the ECMO circuit reaches the brain, triggering an increased respiratory rate despite paradoxically low CO2 levels in the right radial artery. This leads to a cycle of worsening hypercapnia, respiratory distress, and potential neurological injury. Proper CO2 monitoring strategies are needed to prevent mismanagement.

The Role of Continuous Monitoring of Venous Drainage Flow and Integrated Oxygen Extraction (ERiO2) via Bilateral Near-Infrared Spectroscopy in Cerebral Perfusion During Aortic Arch Surgery

March 6, 2025 No Comments

This study evaluates the role of continuous monitoring of venous drainage flow and oxygen extraction (ERiO2) using near-infrared spectroscopy (NIRS) in cerebral perfusion during aortic arch surgery. A retrospective review of 10 patients undergoing selective antegrade cerebral perfusion (SACP) found a strong correlation (r = 0.91, p < 0.01) between ERiO2 and NIRS-derived regional oxygen saturation (rSO2). The study suggests that integrated monitoring improves perfusion management and neurological outcomes.

Exploring Differences in Surgical Outcomes Depending on the Arterial Cannulation Strategy for Acute Type A Aortic Dissection: A Single-Center Study

July 6, 2024 No Comments

This single-center retrospective study evaluated the impact of different arterial cannulation strategies on surgical outcomes for patients with acute type A aortic dissection (AD) and intramural hematoma (IMH). By comparing 32 patients who underwent antegrade cannulation with 114 patients who underwent retrograde cannulation, the study found significant differences in total surgical time and intensive care unit stay duration. However, no significant differences were observed in 30-day mortality or postoperative cerebrovascular accident rates. The findings suggest that the choice of cannulation strategy should be tailored to individual patient needs.