Three-Vessel Versus Unilateral Antegrade Cerebral Perfusion in Emergency Total Arch Replacement for Acute Type A Aortic Dissection

NCT07043777 | Completed

• 1 other identifier: CMUH114-REC1-089
• Study Type: observational
• Target: 201
• Locations: 1 country
• Sites: 1

Brief Summary

This single-centre retrospective observational cohort study describes the technical feasibility of direct three-vessel antegrade cerebral perfusion, designated modified antegrade cerebral perfusion (MACP), during emergency total arch replacement for acute type A aortic dissection. MACP delivers antegrade cerebral perfusion directly to the brachiocephalic, left common carotid, and left subclavian arteries. Outcomes are summarised descriptively and compared exploratorily with unilateral right axillary antegrade cerebral perfusion (uACP). Because perfusion strategy and treating surgeon were completely confounded, the comparative analyses are intended only to contextualise the technical experience and generate hypotheses.

Conditions

Acute Type A Aortic Dissection

Keywords

Cerebral Protection; Neurologic Complications; Retrospective Cohort; Cardiovascular Surgery; China Medical University Hospital; Direct Three-Vessel Antegrade Cerebral Perfusion; Modified Antegrade Cerebral Perfusion; Unilateral Antegrade Cerebral Perfusion; Total Arch Replacement; Acute Type A Aortic Dissection; Postoperative Stroke

Outcome Measures

Primary Outcomes (1)

• Postoperative Stroke

  Postoperative stroke during the index admission, defined as an abrupt focal neurological deficit due to cerebral infarction or intracranial haemorrhage confirmed on postoperative computed tomography or magnetic resonance imaging and adjudicated by a consultant neurologist.

  During the index admission, up to hospital discharge.

Secondary Outcomes (10)

• In-Hospital Mortality

  During the index admission, up to hospital discharge.

• Hospital Length of Stay

  From surgery to hospital discharge.

• ICU Length of Stay

  From postoperative ICU admission to ICU discharge during the index admission.

• Mechanical Ventilation Duration

  During the index admission, up to liberation from invasive ventilation.

• Postoperative Acute Kidney Injury (AKI)

  Within 7 postoperative days.

Study Arms (2)

Direct Three-Vessel ACP (MACP) Group

Patients undergoing emergency total arch replacement for acute type A aortic dissection in whom direct three-vessel antegrade cerebral perfusion was delivered to the brachiocephalic, left common carotid, and left subclavian arteries.

Procedure: Direct Three-Vessel Antegrade Cerebral Perfusion (MACP)

Unilateral Right Axillary ACP (uACP) Group

Patients undergoing emergency total arch replacement for acute type A aortic dissection in whom antegrade cerebral perfusion was delivered unilaterally through right axillary artery cannulation.

Procedure: Unilateral Right Axillary Antegrade Cerebral Perfusion (uACP)

Interventions

Unilateral Right Axillary Antegrade Cerebral Perfusion (uACP) PROCEDURE

Unilateral antegrade cerebral perfusion delivered through right axillary artery cannulation during emergency total arch replacement.

Unilateral Right Axillary ACP (uACP) Group

Direct Three-Vessel Antegrade Cerebral Perfusion (MACP) PROCEDURE

Direct antegrade cerebral perfusion through balloon-tipped catheters inserted into the brachiocephalic, left common carotid, and left subclavian arteries during emergency total arch replacement.

Direct Three-Vessel ACP (MACP) Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Non-Probability Sample

Study Population

Consecutive adult patients who underwent emergency total arch replacement for acute type A aortic dissection at China Medical University Hospital, Taichung, Taiwan, between 1 January 2021 and 30 April 2025. The analytic population was restricted to patients who received either direct three-vessel antegrade cerebral perfusion (MACP) or unilateral right axillary antegrade cerebral perfusion (uACP).

You may qualify if:

• Adults aged 18 years or older.
• Patients who underwent emergency total arch replacement for acute type A aortic dissection at China Medical University Hospital between 1 January 2021 and 30 April 2025.
• Patients who received either direct three-vessel antegrade cerebral perfusion (MACP) or unilateral right axillary antegrade cerebral perfusion (uACP).

You may not qualify if:

• Incomplete key clinical, operative, or outcome data precluding analysis.
• Preoperative modified Rankin Scale score of 4 or higher.
• Ischemic stroke within 30 days before surgery.
• Remote prior stroke history or unavailable prior-stroke status.
• Patients managed with cerebral perfusion strategies other than MACP or uACP.

Sponsors & Collaborators

• China Medical University Hospital: lead

Study Sites (1)

China Medical University Hospital

Taichung, 40447, Taiwan

Location

Related Publications (1)

• Pitts L, Kofler M, Montagner M, Heck R, Iske J, Buz S, Kurz SD, Starck C, Falk V, Kempfert J. Cerebral Protection Strategies and Stroke in Surgery for Acute Type A Aortic Dissection. J Clin Med. 2023 Mar 15;12(6):2271. doi: 10.3390/jcm12062271.

  PMID: 36983272 BACKGROUND

Study Officials

• En-Bo Wu, M.D.

  Department of Anesthesiology, China Medical University Hospital

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: observational
• Observational Model: COHORT
• Time Perspective: RETROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: June 20, 2025
• First Posted: June 29, 2025
• Study Start: January 1, 2021
• Primary Completion: April 30, 2025
• Study Completion: June 1, 2025
• Last Updated: July 1, 2026

Record last verified: 2026-06

Data Sharing

• IPD Sharing: Will not share

Locations

TW (1)