The Impact of Optimal Cerebral Perfusion Pressure on Postoperative Neurologic Outcome - A Propensity Score Analysis of 800 Patients with Selective Antegrade Cerebral Perfusion in Aortic Surgery

Background: Selective antigrade cerebral perfusion (SACP) is important in the surgery of the major aorta, since it prolongs the cerebral ischemia time and protects the brain. Although many center employ this method, the protocol of SACPs is rather not a standardized method. Herein, we use a flow managed, pressure controlled antigrade cerebral perfusion method with a flow set point since 1999. A priori our interest has been to see the potential relationship between perfusion pressure and neurologic outcome under our clinical setting, and lastly does a selective supplement of higher cerebral perfusion pressure show a better neurologic condition.

Methods: Data of 800 patients with selective cerebral perfusion during aortic surgery were collected. We used a cluster analysis and could accordingly pick a total of 50 patients to build a high selective cerebral perfusion group and 51 patients to build a low selective perfusion group. Then, we used a propensity score for the “re-randomization” of the two groups to evaluate the comparability. at last we performed statistic analyses of postoperative neurologic outcome.

Results: Overall, the results of 800 patients cohort showed that the flow managed, pressure controlled cerebral perfusions method provided sufficient cerebral tissue perfusion. There is no difference on neurologic complications rate between the groups with high selective cerebral perfusion pressure (mean 79.61 ± 14.97 mm Hg) and low perfusion pressure (mean 53.64 ± 12.09 mm Hg).

Conclusions: In conclusion, our results show a first time presentation of antigrade cerebral perfusion data as a real time curve of a large patient cohort containing a total of 800 patients. We demonstrate that under our clinic setting, using our perfusion strategy with a lower selective cerebral perfusion pressure (∼50 mm Hg versus ∼80 mm Hg) is not associated with a higher neurologic complication rate during aortic surgery.