Angeloni et al conducted an updated meta-analysis of publications of patients undergoing complex aortic surgery requiring circulatory arrest and compared the outcomes or patients receiving unilateral antegrade selective cerebral perfusion (U-ASCP) and bilateral antegrade selective cerebral perfusion (B-ASCP). Outcome measures were mortality, permanent and temporary neurological dysfunction.
The meta-analysis included 32 publications reporting on 6,788 patients, of whom 3,723 received bilateral ASCP and 3,065 received unilateral ASCP. There were no statistically significant differences in cardiopulmonary bypass times (181.8 ± 47.3 mins for u-ASCP versus 199.8 ± 42.4 for b-ASCP p=0.12) circulatory arrest time (38.5 ±24.3 mins Vs 42.6±28.7 mins p=0.11) or circulatory arrest temperature ( 23.9±3.4 versus 23.1±4.5 p=0.65)
Pooled data demonstrated no difference in mortality, permanent or temporary neurological dysfunction between U-ASCP and B-ASCP. However, meta-regression analysis demonstrated higher mortality in patient receiving U-ASCP with circulatory arrest greater than 30minutes (model Q 65.8 p<0.0001), while there was no increase in mortality in patients receiving B-ASCP for longer circulatory arrest times (model Q 25.7, p=0.27).
The authors suggest that U-ASCP may be appropriate for procedures with a short anticipated circulatory arrest time, otherwise there has been a demonstrable benefit for adopting B-ASCP.
The full manuscript is available here