A novel two-roller pump technique for direct carotid artery reperfusion in acute type A aortic dissection with cerebral malperfusion.

Objectives: Cerebral malperfusion is a devastating complication of acute type A aortic dissection that markedly increases perioperative mortality and morbidity. Despite central aortic repair with antegrade selective cerebral perfusion, insufficient reperfusion of the occluded carotid artery may lead to severe neurological injury. To overcome this limitation, we modified the conventional single-roller pump antegrade selective cerebral perfusion and introduced a 2-roller pump technique for direct carotid artery reperfusion during acute type A aortic dissection repair. Methods: Between January 2022 and December 2024, 112 patients underwent emergency surgery for acute type A aortic dissection at our institution. Of these, 15 (13.4%) presented with severe stenosis or occlusion of the common carotid artery and received direct common carotid artery reperfusion. Patients were divided into 2 groups: single-roller pump antegrade selective cerebral perfusion (n = 7) and 2-roller pump antegrade selective cerebral perfusion (n = 8). In the 2-roller pump technique, separate cerebral perfusion circuits were used for the malperfused carotid artery and the remaining neck vessels, allowing independent flow regulation. Results: Baseline characteristics, operative parameters, and systemic outcomes were comparable between groups. No in-hospital deaths occurred in either group. Neurological deterioration was observed in 2 patients (28.6%) in the single-roller pump group, whereas no patient worsened in the 2-roller pump group. All symptomatic patients in the 2-pump group showed postoperative neurological improvement. No complications related to carotid exposure or 2-pump perfusion were identified. Conclusions: The 2-roller pump technique provides reliable perfusion to both dissected and unaffected neck vessels, potentially reducing the risk of cerebral ischemia. This strategy is safe and feasible, and may improve neurological outcomes in patients with acute type A aortic dissection and carotid malperfusion.