Objective Spinal cord injury (SCI) with subsequent paraplegia and/or stroke after arch repair with frozen elephant trunk (FET) remain the most devastating complications. In this study, we aim to examine the impact of different cerebral perfusion strategies on the neurological outcome comparing bilateral antegrade cerebral perfusion (bACP) and trilateral antegrade cerebral perfusion (tACP).

Methods Between 2009 and 2021, 88 patients underwent total arch replacement using a hybrid prosthesis in FET technique for acute (40.4%) and chronic (59.6%) aortic pathologies. After excluding 14 patients who underwent FET with unilateral ACP the remaining 74 patients were divided into two groups. Propensity score matching was performed based on pre- and perioperative patient characteristics resulting in 22 patients in each group. The primary endpoint was a combination of major cerebral event and SCI. Secondary end point was all-cause mortality.

Results Major cerebral events occurred in 9% of the patients in bACP versus 13.6% in tACP group (p = 0.63). No postoperative SCI was observed in patients with bACP and only one patient suffered SCI with tACP (p = 0.31). There was no significant difference in 30-day mortality between the two groups (22.7% in bACP vs. 13.6% in tACP; p = 0.43).

Conclusion In patients undergoing total aortic arch repair using FET technique, both perfusion strategies (bilateral and trilateral ACP) are safe and effective. The rates of neurological complications as well as mortalities are acceptably low in both groups. Further studies with larger patient cohorts are warranted.

目的 冷冻象鼻 (FET) 修复足弓后脊髓损伤 (SCI) 以及随之而来的截瘫和/或中风仍然是最具破坏性的并发症。在本研究中，我们旨在比较双侧顺行脑灌注（bACP）和三侧顺行脑灌注（tACP），检查不同脑灌注策略对神经学结果的影响。

方法 2009 年至 2021 年间，88 名患者因急性（40.4%）和慢性（59.6%）主动脉病变接受了 FET 技术混合假体全弓置换术。排除 14 名接受 FET 联合单侧 ACP 的患者后，其余 74 名患者被分为两组。根据术前和围手术期患者特征进行倾向评分匹配，每组 22 名患者。主要终点是主要脑事件和 SCI 的组合。次要终点是全因死亡率。

结果 bACP 组中 9% 的患者发生主要脑事件，而 tACP 组中这一比例为 13.6%（p  = 0.63）。bACP 患者中未观察到术后 SCI，只有 1 名 tACP 患者出现 SCI（p  = 0.31）。两组之间的 30 天死亡率没有显着差异（bACP 为 22.7%，tACP 为 13.6%；p  = 0.43）。

结论 在采用 FET 技术进行全主动脉弓修复的患者中，两种灌注策略（双侧和三侧 ACP）都是安全有效的。两组的神经并发症发生率和死亡率都较低，可以接受。有必要对更大的患者群体进行进一步的研究。