Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study

BMC Cardiovasc Disord. 2021 Apr 20;21(1):193. doi: 10.1186/s12872-021-02002-9.

Abstract

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 .

Keywords: Antegrade cerebral perfusion; Retrograde inferior vena caval perfusion; Total aortic arch replacement surgery.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / physiopathology
  • Aorta, Thoracic / surgery*
  • Aortic Aneurysm, Thoracic / diagnostic imaging
  • Aortic Aneurysm, Thoracic / mortality
  • Aortic Aneurysm, Thoracic / physiopathology
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Dissection / diagnostic imaging
  • Aortic Dissection / mortality
  • Aortic Dissection / physiopathology
  • Aortic Dissection / surgery*
  • Blood Vessel Prosthesis Implantation* / adverse effects
  • Blood Vessel Prosthesis Implantation* / mortality
  • Cerebrovascular Circulation
  • China
  • Female
  • Humans
  • Male
  • Middle Aged
  • Perfusion* / adverse effects
  • Perfusion* / mortality
  • Pilot Projects
  • Postoperative Complications / mortality
  • Postoperative Complications / therapy
  • Prospective Studies
  • Regional Blood Flow
  • Time Factors
  • Treatment Outcome
  • Vena Cava, Inferior / diagnostic imaging
  • Vena Cava, Inferior / physiopathology*

Associated data

  • ClinicalTrials.gov/NCT03607786