Retrograde Cerebral Perfusion in Type A Aortic Dissection Repair Is Associated With Higher Rates of Postoperative Complications.

Background The comparative short- and long-term outcomes of retrograde versus antegrade cerebral perfusion during circulatory arrest for acute type A aortic dissection repair remain debated. Methods In this single-center retrospective study, postoperative outcomes were compared between retrograde and antegrade cerebral perfusion. Retrograde cerebral perfusion was employed in older patients (median age = 72 vs. 63 years; p = 0.030), with comparable body mass index (29 vs. 28 kg/m²; p = 0.649). Results Relative to antegrade cerebral perfusion, retrograde cerebral perfusion was associated with increased 30-day mortality (40% vs. 13%; p = 0.003), postoperative pericardial and pleural effusion (75% vs. 43%; p = 0.009), and cerebrovascular accident (35% vs. 16%; p = 0.044). After multivariable adjustment for circulatory arrest time and nadir hypothermic temperature, retrograde perfusion independently predicted 30-day mortality (adjusted odds ratio: 7.66; 95% CI: 2.16-27.13; p = 0.002). Conclusions These findings suggest that retrograde cerebral perfusion is associated with worse postoperative outcomes following acute type A aortic dissection repair and warrant further investigation.