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BMC Cardiovascular Disorders

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Open Access 01-12-2021 | Circulatory Arrest | Research article

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

Authors: Jing Lin, Zhen Qin, Xinhao Liu, Jiyue Xiong, Zhong Wu, Yingqiang Guo, Deying Kang, Lei Du

Published in: BMC Cardiovascular Disorders | Issue 1/2021

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.

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Title: Retrograde inferior vena caval perfusion for total aortic arch replacement surgery: a randomized pilot study
Authors: Jing Lin
Zhen Qin
Xinhao Liu
Jiyue Xiong
Zhong Wu
Yingqiang Guo
Deying Kang
Lei Du
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Circulatory Arrest
Aortic Dissection
Published in: BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-021-02002-9

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