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The Japan Cardiovascular Surgery Database Organization Usui A, Miyata H, Ueda Y

Risk-adjusted and Case-matched Comparative Study Comparing Antegrade and Retrograde Cerebral Perfusion in Aortic Arch Surgery Based on the Japan Adult Cardiovascular Surgery Database. The Japan Cardiovascular Surgery Database Organization Usui A, Miyata H, Ueda Y Motomura N, Takamoto S.

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The Japan Cardiovascular Surgery Database Organization Usui A, Miyata H, Ueda Y

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  1. Risk-adjusted and Case-matched Comparative Study Comparing Antegrade and Retrograde Cerebral Perfusion in Aortic Arch SurgeryBased on the Japan Adult Cardiovascular Surgery Database The Japan Cardiovascular Surgery Database Organization Usui A, Miyata H, Ueda Y Motomura N, Takamoto S

  2. Objective • Antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP) are two techniques for brain protection in aortic arch surgery. • We conducted a large-scaled, comparative clinical study between ACP and RCP to evaluate up-to-date clinical outcomes based upon Japan Adult Cardiovascular Surgery Database (JACVSD).

  3. Patients selection 2005-2007 116 institutes 8470 aortic surgery Use of ACP or RCP 3359 ACP 1232 RCP Ascending or arch AO Elective surgery No-dissection 10 pt./year < (65 institutes) Statistical analysis 1185 ACP 392 RCP Risk adjusted analysis 463 ACP 304 RCP Matched pair analysis

  4. End points • Mortality • 30 days mortality • Operative mortality • In-hospital complications: • CNS dysfunction (Stroke, TIA, Coma) • Paraparesis / paraplegia • Reoperation for any reason • Prolonged ventilation 24< hours • Renal failure required dialysis • Deep sternal wound infection

  5. Patients Characteristics for Risk Adjusted Analysis

  6. Risk Adjusted Analysis

  7. Patient Characteristics by Propensity-matched Pairs

  8. Propensity-matched Analysis

  9. Effect of RCP in subgroups of patients Range of replacement showed no significant effect of RCP for operative mortality.

  10. Effect of RCP in subgroups of patients

  11. Effect of RCP for Mortality and Neurologic dysfunction Risk adjusted analysis Propensity-matched analysis 30 day mortality Operative mortality Stroke Transient neurologic dysfunction Coma Paraparesis RCP showed no significant effect for operative mortality and neurologic dysfunction.

  12. Conclusion • This is the first clinical study based on a large scaled database. • Both RCP and ACP provide excellent and comparable clinical outcomes including mortality, stroke and other morbidity. • Brain protection has been applied for aortic arch surgery in reasonable selection criteria in Japan.

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