{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T19:42:22Z","timestamp":1771530142616,"version":"3.50.1"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2019,4,21]],"date-time":"2019-04-21T00:00:00Z","timestamp":1555804800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES<\/jats:title><jats:p>We retrospectively evaluated the outcome after elective aortic arch surgery with circulatory arrest to determine the impact of different brain protection strategies on neurological outcome and early and late survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>A total of 925 patients were included. The patients were assigned to 2 groups based on the type of cerebral protection strategy used during circulatory arrest [hypothermic circulatory arrest (HCA) n\u2009=\u2009224; antegrade selective cerebral perfusion (ASCP) n\u2009=\u2009701]. The propensity score matching (1:1; 210 vs 210 patients) approach was used to minimize selection bias and to obtain comparable groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>The overall in-hospital mortality and permanent focal neurological deficit rates were 5.6% (n\u2009=\u200952) and 5.4% (n\u2009=\u200950) and were significantly lower in patients who received ASCP (4.4% and 3.4%, respectively) as compared to those who underwent HCA (9.4% and 11.6%, respectively) (P\u2009=\u20090.005 and P\u2009&lt;\u20090.001). The propensity-matched analysis showed significantly lower rates of in-hospital mortality [3.8% vs 9.5% (HCA)] and permanent focal neurological deficit in ASCP group [2.9% vs 11.9% (HCA)]. Multivariable logistic regression analysis revealed left ventricular ejection fraction &lt;30%, age &gt;70\u2009years, coronary artery disease, circulatory arrest time &gt;40\u2009min and mitral valve disease as independent predictors of in-hospital mortality. The use of ASCP was protective for early survival. Cox regression analysis revealed that long-term mortality was independently predicted by age, left ventricular ejection fraction &lt;30%, total arch replacement, prior cardiac surgery, PVD, chronic obstructive pulmonary disease and previous stroke, whereas ASCP was protective for late survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Elective aortic arch surgery is associated with acceptable early and late outcomes. The ASCP is associated with a significant reduction in-hospital mortality and occurrence of permanent neurological deficits.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezz091","type":"journal-article","created":{"date-parts":[[2019,4,10]],"date-time":"2019-04-10T19:12:30Z","timestamp":1554923550000},"page":"1001-1008","source":"Crossref","is-referenced-by-count":15,"title":["Antegrade selective cerebral perfusion reduced in-hospital mortality and permanent focal neurological deficit in patients with elective aortic arch surgery\u2020"],"prefix":"10.1093","volume":"56","author":[{"given":"Sergey","family":"Leontyev","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piroze M","family":"Davierwala","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mikhail","family":"Semenov","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Konstantin","family":"von Aspern","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gunter","family":"Krog","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thilo","family":"Noack","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Misfeld","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael A","family":"Borger","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,4,21]]},"reference":[{"key":"2019101705191365400_ezz091-B1","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/S0022-5223(03)01046-8","article-title":"Risk factors of mortality and permanent neurologic injury in patients undergoing ascending aortic and arch repair","volume":"126","author":"Czerny","year":"2003","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019101705191365400_ezz091-B2","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1016\/j.jtcvs.2007.07.067","article-title":"Hypothermic circulatory arrest with selective antegrade cerebral perfusion in ascending aortic and aortic arch surgery: a risk factor analysis for adverse outcome in 501 patients","volume":"135","author":"Khaladj","year":"2008","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2019101705191365400_ezz091-B3","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.1016\/j.ejcts.2009.12.029","article-title":"Cerebral functions and metabolism after antegrade selective cerebral perfusion in aortic arch surgery","volume":"37","author":"Pacini","year":"2010","journal-title":"Eur J Cardiothorac Surg"},{"key":"2019101705191365400_ezz091-B4","doi-asserted-by":"crossref","first-page":"1502","DOI":"10.1016\/j.athoracsur.2012.01.106","article-title":"What is the best strategy for brain protection in patients undergoing aortic arch surgery? 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