Unilateral Versus Bilateral Antegrade Cerebral Perfusion in Aortic Arch Surgery: Systematic Review and Meta-Analysis of Randomised Controlled Trials and Propensity-Matched Studies.

Abstract

Background: Selective antegrade cerebral perfusion, via unilateral antegrade cerebral perfusion (uACP) or bilateral antegrade cerebral perfusion (bACP) approaches, is used in aortic arch surgery to protect the brain during circulatory arrest. Previous meta-analyses, based on unmatched observational data, found no differences between these techniques. Our updated meta-analysis exclusively examines high-quality evidence from randomised controlled trials and propensity-matched studies.

Method: A literature search of MEDLINE, Scopus, and Cochrane databases identified relevant studies up to November 2024. Pooled odds ratios (ORs) and mean differences with 95% confidence intervals (CIs) were calculated using RevMan version 8.13.0.

Results: We included eight studies comprising 2,072 patients, with 1,025 (49.5%) patients in the uACP group. The pooled analysis revealed that uACP was associated with a shorter hospital length of stay (mean differences -2.2 days; 95% CI -3.6 to -0.7; p<0.05) and a reduced incidence of permanent neurological dysfunction (OR 0.7; 95% CI 0.5 to 0.9; p<0.05). However, uACP was linked to a higher incidence of acute kidney injury (OR 1.5; 95% CI 1.1 to 2.0; p<0.05). No statistically significant differences were observed between uACP and bACP in terms of aortic cross-clamp time, cardiopulmonary bypass duration, ventilation time, transient neurological deficits, intensive care unit length of stay, 30-day mortality, and re-exploration for bleeding.

Conclusions: Our meta-analysis confirmed several comparable outcomes between uACP and bACP as reported in previous reviews. However, our study identified additional findings, such as a reduced hospital length of stay and lower incidence of permanent neurological dysfunction associated with uACP, alongside a higher risk of acute kidney injury.