Perfusione cerebrale selettiva anterograda: influenza della pressione e dei flussi di perfusione sull’outcome neurologico in pazienti sottoposti a chirurgia dell’arco aortico

Introduction Aortic arch surgery is still associated with significant high mortality and morbidity rate caused by neurological complications. Antegrade selective cerebral perfusion (ASCP) is an effective method of brain protection. Aim of this manuscript is to evaluate the influence of cerebral perfusion flow and pressure on post-operative outcomes in patients undergoing aortic arch surgery at two high- volume cardiac surgery centers. Methods Between January 2015 and August 2020, 519 consecutive patients underwent aortic arch surgery with ASCP at Cardiac Surgery Unit of the University of Bologna and at Cardiac Surgery Unit of the “Ospedali Riuniti” of Ancona. The mean age was 65.9±11.5 years. Main indications were acute aortic syndrome (286 patients) and chronic aortic disease (233 patients). Patients were divided into three groups based on cerebral perfusion flow: A <9 mL/Kg/min (12.7%), B 10-11 mL/Kg/min (43.7%) and C> 11 mL/Kg/min (43.6%). Results Hospital mortality was 11.9%. Permanent neurological dysfunction (PND) was observed in 44 patients (8.5%). The multivariate analysis revealed urgency status (p=0.032; OR: 2.3; IC: 1.07-5.05) to be independent determinant for PND. Transient neurological dysfunction (TND) occurred in 115 patients (22.2%). A cerebral perfusion flow > 11 ml/Kg/min (p=0.041; OR: 2.18; IC: 1.03-4.63) and urgency status (p=0.014OR: 1.85; IC: 1.13-3.02) were independent determinants of TND. Conclusions ASCP is an effective and safe method of brain protection, allowing time-consuming aortic repairs to be performed, with encouraging results in terms of hospital mortality and neurologic outcome. Looking at our finding, an ASCP flow < 11 mL/Kg/min seems to be safety and efficacious. Higher cerebral flow could be associated with an increased risk of TND.