"Brain-First" Total Body Retrograde Perfusion and Retrograde Cerebral Perfusion in Hemi-Arch Replacement

Objective: The purpose of this study is to compare the early outcomes of brain-first total body retrograde perfusion (Bf-TBRP) in comparison with reverse cerebral perfusion (RCP) under moderate hypothermia circulatory arrest (MHCA) for hemi-arch replacement surgery. Methods: We analyzed the data of 88 patients who underwent hemi-arch replacement with Bf-TBRP (n = 18) or RCP (n = 70) under MHCA at West China Hospital of Sichuan University between 1 January 2020, and 31 July 2022. In-hospital mortality, neurological deficits, and other adverse events were recorded, which were evaluated with logistic regression to determine risk factors. Results: There was no significant difference between the Bf-TBRP and RCP groups in in-hospital mortality, cardiac events, neurological deficits, dialysis, gastrointestinal complications, and paralysis (p > 0.05). The Bf-TBRP group was associated with significantly shorter hospital stay [Bf-TBRP: 8 d (interquartile range (IQR), 7–10) vs. RCP: 10 d (IQR, 8–13), p = 0.03] and fewer platelet transfusions [Bf-TBRP: 1.0 (IQR, 0–1.0) vs. RCP: 1.0 (IQR, 1.0–2.0), p = 0.05] than the RCP group. On multivariable logistic regression analysis, emergency surgery (p = 0.05) and surgery duration (p = 0.03) were determined to be risk factors. Conclusions: The study showed that Bf-TBRP is a safe technique for patients undergoing hemi-arch replacement with MHCA.