Guo Shasha, Sun Yanhua, Ji Bingyang, Liu Jinping, Wang Guyan, Zheng Zhe
Department of Cardiopulmonary Bypass, State Key Laboratory of Cardiovascular Medicine, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China.
Artif Organs. 2015 Apr;39(4):300-8. doi: 10.1111/aor.12376. Epub 2015 Mar 4.
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.
在主动脉弓手术中，深度低温停循环（DHCA）联合脑灌注在全球范围内被作为常规操作使用。尽管顺行性脑灌注（ACP）比逆行性脑灌注（RCP）应用更为广泛，但DHCA期间ACP和RCP在获益和风险方面的差异尚不确定。本荟萃分析的目的是比较在DHCA期间接受主动脉手术的患者中，ACP和RCP在神经学结局和早期死亡率方面的差异。使用关键词“顺行”“逆行”“脑灌注”“心肺转流”“体外循环”和“心脏手术”检索了PubMed、EMBASE和Cochrane图书馆，以查找报告在需要DHCA联合ACP或RCP的主动脉手术中包括早期死亡率、中风、短暂性神经功能障碍（TND）和永久性神经功能障碍（PND）等临床终点的研究。采用Cochrane Q统计量和I²统计量分析异质性。用Begg漏斗图和Egger检验检测发表偏倚。本荟萃分析纳入了34项研究，其中4262例患者接受了DHCA + ACP，2761例接受了DHCA + RCP。TND的总体合并相对风险为0.722（95%CI = [0.579, 0.900]），总体效应的z值为2.9（P = 0.004）。异质性较低（I² = 18.7%）。分析表明，在TND方面，接受DHCA + ACP的患者比接受DHCA + RCP的患者结局更好，而在PND、中风和早期死亡率方面两组之间无显著差异。本荟萃分析表明，在TND方面，DHCA + ACP比DHCA + RCP具有优势，而在PND、早期死亡率和中风方面，这两种方法显示出相似的结果。
