Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch.

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Similar cerebral protective effectiveness of antegrade and retrograde cerebral perfusion combined with deep hypothermia circulatory arrest in aortic arch surgery: A meta- analysis and systematic review of 5060 patients Zhipeng Hu, PhD, Zhiwei Wang, MD, Zongli Ren, MD, Hongbing Wu, PhD, Min Zhang, MD, Hao Zhang, PhD, Xiaoping Hu, MD The Journal of Thoracic and Cardiovascular Surgery Volume 148, Issue 2, Pages 544-560 (August 2014) DOI: 10.1016/j.jtcvs.2013.10.036 Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Flow diagram of study selection. TND, Transient neurologic dysfunction; PND, permanent neurologic dysfunction. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Quality assessment of each original study. ACP, Antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; RR, relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for morbidity of postoperative stroke. RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Funnel plot of comparison: Morbidity of postoperative stroke. ACP, Antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; TND, transient neurologic dysfunction; RR, relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for morbidity of postoperative transient neurologic dysfunction (TND). RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 Funnel plot of comparison: Morbidity of postoperative transient neurologic dysfunction. ACP, Antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; PND, permanent neurologic dysfunction; RR, relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 7 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for morbidity of postoperative permanent neurologic dysfunction (PND). RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 8 Funnel plot of comparison: Morbidity of postoperative permanent neurologic dysfunction. ACP, Antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; RR, relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 9 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for postoperative in-hospital mortality. RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 10 Funnel plot of comparison: Postoperative in-hospital mortality. se, Standard error; RR, relative risk. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 11 Sensitivity analysis of stroke indicating that exclusion of the study by Usui and colleagues20 changes the total results most obviously. ACP, Antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; RR, relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 12 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for morbidity of postoperative stroke after study by Usui and colleagues20 was excluded. RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 13 Sensitivity analysis of history of central neurologic events indicating that exclusion of study by Usui and colleagues20 changes the total results most obviously. ACP, Antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; HCNE, history of central neurologic events; RR, relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 14 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for history of central neurologic events (HCNE) as 1 of the baseline data. RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions

Figure 15 Comparison of antegrade cerebral perfusion (ACP) versus retrograde cerebral perfusion (RCP) for history of central neurologic events (HCNE) after the study by Usui and colleagues20 was excluded. RR, Relative risk; CI, confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2014 148, 544-560DOI: (10.1016/j.jtcvs.2013.10.036) Copyright © 2014 The American Association for Thoracic Surgery Terms and Conditions