Analysis of the Brain Protective Effect of Flow Percentage Cerebral Perfusion Combined With Unilateral Antegrade Selective Cerebral Perfusion in Acute Aortic Dissection Arch Reconstruction Surgery

Background: To evaluate the neuroprotective efficacy of combining unilateral antegrade selective cerebral perfusion with percentage-controlled flow regulation during aortic arch reconstruction surgery for aortic dissection. Methods: A retrospective analysis was conducted using clinical data from 226 consecutive patients who underwent surgery for acute aortic dissection with arch reconstruction at our hospital between January 2020 and January 2021. Based on the cerebral protection strategy used, patients were divided into two groups: the percentage-flow cerebral perfusion group (n = 89) and the control group (n = 137). The severity of neurological impairment was rigorously evaluated using standardized biomarker assessments, including serial measurements of serum S100β protein and neuron-specific enolase (NSE) levels. These biomarkers were systematically analyzed and compared between the two groups at two critical time points: preoperatively (baseline) and postoperatively during follow-up. Multivariate analysis was subsequently performed to identify independent risk factors associated with postoperative neurological dysfunction following surgical repair. Results: No statistically significant differences were observed in baseline characteristics or intraoperative parameters between the two groups (all p > 0.05). Postoperative mortality was comparable (4.5% vs. 4.4%, p = 0.915). However, the percentage-flow cerebral perfusion group showed a significantly lower incidence of neurological dysfunction—including both temporary and permanent deficits—compared to the conventional control group (8.98% vs. 18.98%, p = 0.031). Additionally, these patients demonstrated significantly shorter times to wakefulness and extubation (both p < 0.05). Serum biomarker analysis further indicated markedly elevated levels of S100β and NSE in the control group relative to the percentage-flow group (both p < 0.05). Univariate and multivariate regression analyses identified age, unilateral cerebral perfusion time, and cardiopulmonary bypass (CPB) time as independent risk factors for postoperative neurological injury. A predictive model incorporating these variables exhibited strong discriminative power (area under the curve, AUC = 0.838) and good stability (p = 0.256). Conclusion: Optimized cerebral perfusion flow significantly shortens the time to awakening and extubation in patients undergoing acute aortic dissection repair, while reducing neurological injury, as supported by decreased serum levels of the biomarkers S100β and NSE. These results indicate a considerable neuroprotective benefit. Moreover, multivariate analysis confirmed that age, unilateral cerebral perfusion duration, and cardiopulmonary bypass (CPB) time are independent risk factors for postoperative neurological impairment. A predictive model integrating these factors exhibited strong clinical applicability.