Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis
Abstract Background Cerebral protection strategies in type A aortic dissection (TAAD) surgery are critical yet inconclusive. We propose an integrated cerebral protection protocol. This study aimed to evaluate the effectiveness of this protocol. Methods From January 2020 to December 2022, 85 patients...
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BMC
2025-02-01
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| Online Access: | https://doi.org/10.1186/s12893-025-02783-2 |
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| author | Fei-min Shen Yi-min Lin Ming-cheng Huang Jin-ping Liu Ling-chen Huang Liang-wan Chen Xiao-fu Dai |
| author_facet | Fei-min Shen Yi-min Lin Ming-cheng Huang Jin-ping Liu Ling-chen Huang Liang-wan Chen Xiao-fu Dai |
| author_sort | Fei-min Shen |
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| description | Abstract Background Cerebral protection strategies in type A aortic dissection (TAAD) surgery are critical yet inconclusive. We propose an integrated cerebral protection protocol. This study aimed to evaluate the effectiveness of this protocol. Methods From January 2020 to December 2022, 85 patients were treated with an integrated protocol incorporating bilateral antegrade cerebral perfusion (ACP) and moderate hypothermia, with measures to prevent the shedding of thrombus or endothelial debris (BACP group), while traditional protocols were applied to 273 additional patients (UACP group). Inverse probability treatment weighting (IPTW) was performed to balance baseline characteristics. Three logistic regression models were used to evaluate the relationship between the two cerebral protection strategies and neurologic complications. Stepwise logistic regression was further employed to identify risk factors for cerebral complications. Results Baseline characteristics were balanced after IPTW adjustment. The BACP group had a significantly shorter operative time (364.79 vs. 397.61 min, P = 0.022), significantly fewer neurologic complications (5.6% vs. 15.9%, P = 0.032), and transient neurologic injury (3.0% vs. 12.5%, P = 0.035). Binary multivariable logistic regression analysis showed that the cerebral complication risk was 3.14 times greater with the traditional protocol compared to the integrated protocol (odds ratio[OR]:3.14, 95%confidence interval[CI]:1.19–8.27, P = 0.020). Stepwise logistic regression confirmed that cerebral complications were dramatically increased with unilateral ACP (OR:2.99, 95%CI:1.14–7.82, P = 0.025), while bilateral ACP had a significant impact on decreasing cerebral complications. Conclusions Our integrated protocol effectively minimizes postoperative cerebral complications. Moderate hypothermia combined with BACP and measures to prevent brain debris could be adopted as an effective strategy for cerebral protection in TAAD surgery. |
| format | Article |
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| language | English |
| publishDate | 2025-02-01 |
| publisher | BMC |
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| series | BMC Surgery |
| spelling | doaj-art-bb59a3ccbae4453c85fe4d7e6f1840502025-08-20T02:12:57ZengBMCBMC Surgery1471-24822025-02-0125111010.1186/s12893-025-02783-2Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysisFei-min Shen0Yi-min Lin1Ming-cheng Huang2Jin-ping Liu3Ling-chen Huang4Liang-wan Chen5Xiao-fu Dai6Department of Cardiac-thoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical UniversityDepartment of Cardiac-thoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical UniversityDepartment of Cardiac-thoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical UniversityDepartment of Cardiac-thoracic Surgery, Zhangzhou Affiliated Hospital of Fujian Medical UniversityDepartment of Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeKey Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province UniversityKey Laboratory of Cardio-Thoracic Surgery, Fujian Medical University, Fujian Province UniversityAbstract Background Cerebral protection strategies in type A aortic dissection (TAAD) surgery are critical yet inconclusive. We propose an integrated cerebral protection protocol. This study aimed to evaluate the effectiveness of this protocol. Methods From January 2020 to December 2022, 85 patients were treated with an integrated protocol incorporating bilateral antegrade cerebral perfusion (ACP) and moderate hypothermia, with measures to prevent the shedding of thrombus or endothelial debris (BACP group), while traditional protocols were applied to 273 additional patients (UACP group). Inverse probability treatment weighting (IPTW) was performed to balance baseline characteristics. Three logistic regression models were used to evaluate the relationship between the two cerebral protection strategies and neurologic complications. Stepwise logistic regression was further employed to identify risk factors for cerebral complications. Results Baseline characteristics were balanced after IPTW adjustment. The BACP group had a significantly shorter operative time (364.79 vs. 397.61 min, P = 0.022), significantly fewer neurologic complications (5.6% vs. 15.9%, P = 0.032), and transient neurologic injury (3.0% vs. 12.5%, P = 0.035). Binary multivariable logistic regression analysis showed that the cerebral complication risk was 3.14 times greater with the traditional protocol compared to the integrated protocol (odds ratio[OR]:3.14, 95%confidence interval[CI]:1.19–8.27, P = 0.020). Stepwise logistic regression confirmed that cerebral complications were dramatically increased with unilateral ACP (OR:2.99, 95%CI:1.14–7.82, P = 0.025), while bilateral ACP had a significant impact on decreasing cerebral complications. Conclusions Our integrated protocol effectively minimizes postoperative cerebral complications. Moderate hypothermia combined with BACP and measures to prevent brain debris could be adopted as an effective strategy for cerebral protection in TAAD surgery.https://doi.org/10.1186/s12893-025-02783-2Cerebral protectionType a aortic dissectionInverse probability treatment weightingSurvival analysis |
| spellingShingle | Fei-min Shen Yi-min Lin Ming-cheng Huang Jin-ping Liu Ling-chen Huang Liang-wan Chen Xiao-fu Dai Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis BMC Surgery Cerebral protection Type a aortic dissection Inverse probability treatment weighting Survival analysis |
| title | Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis |
| title_full | Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis |
| title_fullStr | Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis |
| title_full_unstemmed | Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis |
| title_short | Effectiveness of an integrated cerebral protection protocol in type A aortic dissection surgery: an inverse probability treatment weighting analysis |
| title_sort | effectiveness of an integrated cerebral protection protocol in type a aortic dissection surgery an inverse probability treatment weighting analysis |
| topic | Cerebral protection Type a aortic dissection Inverse probability treatment weighting Survival analysis |
| url | https://doi.org/10.1186/s12893-025-02783-2 |
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