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首页> 外文期刊>Artificial Organs >Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients
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Similar Cerebral Protective Effectiveness of Antegrade and Retrograde Cerebral Perfusion During Deep Hypothermic Circulatory Arrest in Aortic Surgery: A Meta-Analysis of 7023 Patients

机译：深低温热循环停滞在主动脉手术中对整体和逆行脑灌注的类似脑保护作用：荟萃分析7023例患者。

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In aortic arch surgery, deep hypothermic circulatory arrest (DHCA) combined with cerebral perfusion is employed worldwide as a routine practice. Even though antegrade cerebral perfusion (ACP) is more widely used than retrograde cerebral perfusion (RCP), the difference in benefit and risk between ACP and RCP during DHCA is uncertain. The purpose of this meta-analysis is to compare neurologic outcomes and early mortality between ACP and RCP in patients who underwent aortic surgery during DHCA. PubMed, EMBASE, and the Cochrane Library were searched using the key words "antegrade," "retrograde," "cerebral perfusion," "cardiopulmonary bypass," "extracorporeal circulation," and "cardiac surgery" for studies reporting on clinical endpoints including early mortality, stroke, temporary neurologic dysfunction (TND), and permanent neurologic dysfunction (PND) in aortic surgery requiring DHCA with ACP or RCP. Heterogeneity was analyzed with the Cochrane Q statistic and I-2 statistic. Publication bias was tested with Begg's funnel plot and Egger's test. Thirty-four studies were included in this meta-analysis, with 4262 patients undergoing DHCA + ACP and 2761 undergoing DHCA + RCP. The overall pooled relative risk for TND was 0.722 (95% CI = [0.579, 0.900]), and the z-score for overall effect was 2.9 (P = 0.004). There was low heterogeneity (I-2 = 18.7%). The analysis showed that patients undergoing DHCA + ACP had better outcomes than those undergoing DHCA + RCP in terms of TND, while there were no significant differences between groups in terms of PND, stroke, and early mortality. This meta-analysis indicates that DHCA + ACP has an advantage over DHCA + RCP in terms of TND, while the two methods show similar results in terms of PND, early mortality, and stroke.
机译：在主动脉弓外科手术中，深部低温循环骤停（DHCA）与脑灌注相结合已在世界范围内用作常规操作。尽管顺行性脑灌注（RCP）的使用比逆行性脑灌注（RCP）更为广泛，但是在DHCA期间，ACP和RCP之间的获益和风险差异尚不确定。这项荟萃分析的目的是比较DHCA期间接受主动脉手术的患者在ACP和RCP之间的神经系统结局和早期死亡率。使用关键词“顺行”，“逆行”，“脑灌注”，“体外循环”，“体外循环”和“心脏手术”对PubMed，EMBASE和Cochrane库进行搜索，以报告包括早期在内的临床终点需要DHCA和ACP或RCP的主动脉手术的死亡率，中风，暂时性神经功能障碍（TND）和永久性神经功能障碍（PND）。用Cochrane Q统计量和I-2统计量分析了异质性。用贝格的漏斗图和艾格测试检验出版偏倚。该荟萃分析包括34项研究，其中4262例接受DHCA + ACP的患者和2761例接受DHCA + RCP的患者。 TND的总合并相对风险为0.722（95％CI = [0.579，0.900]），总体效果的z评分为2.9（P = 0.004）。异质性低（I-2 = 18.7％）。分析表明，就TND而言，接受DHCA + ACP的患者比接受DHCA + RCP的患者具有更好的结局，而两组在PND，中风和早期死亡率方面无显着差异。这项荟萃分析表明，就TND而言，DHCA + ACP优于DHCA + RCP，而两种方法在PND，早期死亡率和中风方面均显示出相似的结果。

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