Background This meta-analysis compared the outcomes of bilateral cerebral perfusion (BCP) and unilateral cerebral perfusion (UCP) in aortic surgery for acute type A aortic dissection. Methods A systematic literature search identified 12 studies involving 4,547 patients. Pooled odds ratios (OR) with 95% confidence intervals (CI) were calculated to analyze perioperative characteristics, short-term mortality rates, and postoperative neurological complications. Results No significant differences were found between the BCP and UCP groups in terms of cardiopulmonary bypass time, aortic cross clamp time, lowest body temperature, and lower body circulatory arrest time. Short-term mortality rates (OR [95% CI] = 0.87 [0.64–1.19], p = 0.40) and permanent neurological deficits (OR [95% CI] = 1.01 [0.69–1.47], p = 0.96) were comparable between the groups. However, subgroup analysis of studies exclusively involving total arch replacement showed a lower short-term mortality rate (OR [95% CI] = 0.42 [0.28–0.63], p < 0.01) and permanent neurological deficits (OR [95% CI] = 0.53 [0.30–0.92], p = 0.03) in the BCP group. The BCP group also had a lower rate of temporary neurological deficits (OR [95% CI] = 0.70 [0.53–0.93], p = 0.01), particularly in studies exclusively involving total arch replacement (OR [95% CI] = 0.58 [0.40–0.85], p < 0.01). Conclusion This meta-analysis suggests that BCP and UCP yield comparable outcomes. However, BCP may be associated with lower short-term mortality rates and reduced incidence of neurological complications, particularly in cases requiring total arch replacement. BCP should be considered as a preferred cerebral perfusion in specific patient populations.

中文翻译：

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荟萃分析：A 型夹层中的双侧和单侧脑灌注

背景 这项荟萃分析比较了急性 A 型主动脉夹层主动脉手术中双侧脑灌注 (BCP) 和单侧脑灌注 (UCP) 的结果。方法 通过系统文献检索确定了 12 项研究，涉及 4,547 名患者。计算具有 95% 置信区间 (CI) 的合并比值比 (OR)，以分析围手术期特征、短期死亡率和术后神经系统并发症。结果 BCP组和UCP组在体外循环时间、主动脉钳夹时间、最低体温、下体停循环时间方面无显着差异。短期死亡率 (OR [95% CI] = 0.87 [0.64–1.19], p = 0.40) 和永久性神经功能缺损 (OR [95% CI] = 1.01 [0.69–1.47], p = 0.96) 之间具有可比性团体。然而，专门涉及全牙弓置换的研究的亚组分析显示，短期死亡率较低（OR [95% CI] = 0.42 [0.28–0.63]，p < 0.01）和永久性神经功能缺损（OR [95% CI] = BCP 组中为 0.53 [0.30–0.92]，p = 0.03）。BCP 组的暂时性神经功能缺损发生率也较低（OR [95% CI] = 0.70 [0.53-0.93]，p = 0.01），特别是在专门涉及全牙弓置换的研究中（OR [95% CI] = 0.58 [ 0.40–0.85]，p < 0.01）。结论 这项荟萃分析表明，BCP 和 UCP 产生的结果相当。然而，BCP 可能与较低的短期死亡率和神经并发症的发生率降低有关，特别是在需要全牙弓置换的情况下。BCP 应被视为特定患者群体的首选脑灌注。