Evidence map›Paper›PMID 41115650›Full record

ArticleThe Journal of thoracic and cardiovascular surgery2026

Stroke after aortic arch surgery with short circulatory arrest times: The role of cerebral perfusion strategies.

Adham Makarem, Carol Ling, Matthew Beck, Kenneth Shann, Gaetano Paone, Alphonse DeLucia, Kyle Miletic, Stephane Leung, Thoralf Sundt, Donald S Likosky and 2 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in The Journal of thoracic and cardiovascular surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

12 authors.

Adham MakaremDivision of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
Carol LingDepartment of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
Matthew BeckDivision of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
Kenneth ShannDivision of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
Gaetano PaoneDivision of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Ga.
Alphonse DeLuciaDepartment of Cardiac Surgery, University of Michigan Health West, Wyoming, Mich.
Kyle MileticDivision of Cardiac Surgery, Department of Surgery, Henry Ford Hospital, Detroit, Mich.
Stephane LeungDivision of Cardiothoracic Surgery, Corewell Health West Hospital, Grand Rapids, Mich.
Thoralf SundtDivision of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
Donald S LikoskyDepartment of Cardiac Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Mich.
Arminder S JassarDivision of Cardiac Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, Mass. Electronic address: ajassar@mgh.harvard.edu.
PERForm Registry and the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNeuroprotection during aortic arch surgery often involves hypothermia and the use of adjunctive cerebral perfusion. While antegrade cerebral perfusion (ACP) is favored for extended hypothermic circulatory arrest (HCA), debate continues regarding the optimal cerebral protection strategy during shorter durations of circulatory arrest. This study evaluates the association between cerebral perfusion strategies and stroke risk among patients undergoing aortic arch surgery with an HCA time <30 minutes.

methodsRegistry data from 1079 patients across 42 centers who underwent elective aortic surgery with HCA between 2018 and 2024 were analyzed. Patients with aortic dissection, HCA duration >30 minutes, or receiving both ACP and retrograde cerebral perfusion (RCP) were excluded. Cerebral perfusion strategies were categorized as no cerebral perfusion (NCP), RCP, or ACP. Preoperative, intraoperative, and postoperative variables were compared across cerebral perfusion strategies. Multivariable logistic regression was used to assess the associations between perfusion strategy and postoperative stroke, adjusting for age, sex, race, prior stroke, chronic lung disease, lowest HCA temperature, cardiopulmonary bypass (CPB) time, and duration of circulatory arrest.

resultsACP was the most common strategy (n = 560; 51.9%), followed by RCP (n = 264; 24.5%) and NCP (n = 255; 23.6%). Baseline characteristics were similar across cerebral perfusion strategies, although chronic lung disease was more frequent among ACP patients. The median HCA temperature was 19.4 °C (interquartile range [IQR], 18.0 °C-24.4 °C) in the NCP group, 25.8 °C (IQR, 22.9 °C-27.7 °C) in the ACP group, and 21.6 °C (IQR, 18.9 °C-23.5 °C) in the RCP group (P < .01). In the 3 groups, the median HCA time was 14 (IQR, 10-20) minutes, 14 (IQR, 9-20) minutes, and 16 (IQR, 13-19) minutes, and median CPB time was 201 (IQR, 158-250) minutes, 154 (IQR, 115-207) minutes, and 172 (IQR, 132-214) minutes, respectively (P < .01). Stroke rates were lowest in the RCP group, with an 86.5% reduction in the adjusted odds of stroke compared to NCP (adjusted odds ratio, 0.135, 95% confidence interval, 0.023-0.783; P = .03). There was a nonsignificant protective effect associated with ACP.

conclusionsIn this large, multicenter cohort of patients undergoing elective aortic arch surgery with short HCA times, RCP was associated with a significantly lower risk of postoperative stroke compared to NCP. Physician-led quality improvement collaboratives may provide an effective mechanism for advancing performance related to cerebral perfusion strategies and mitigation of stroke in the setting of elective aortic arch surgery with short circulatory arrest.

Indexed as

Aorta, ThoracicCerebrovascular CirculationCirculatory Arrest, Deep Hypothermia InducedPerfusionStrokeAgedFemaleHumansHypothermia, InducedMaleMiddle AgedRegistriesRetrospective StudiesRisk AssessmentRisk FactorsTime Factorsaortic arch surgerycerebral perfusionpostoperative strokeretrograde cerebral perfusion

Identifiers

PMID41115650

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.