Table 5. Outcome of each study.
| Study | Surgery strategy | Outcome |
|---|---|---|
| Usui 1999 (23) | ACP vs. RCP | RCP is preferred over ACP. Moreover, RCP decreases the chance of brain embolization |
| Zierer 2005 (24) | ACP vs. RCP | The antegrade group had a higher mortality rate. The ACP group had lower CPB time, and ACP was effective in cerebral protection |
| Williams 2012 (22) | ACP vs. RCP | ACP group had a higher mortality rate. The study suffered from selection bias |
| Shemirani 2017 (36) | ACP vs. RCP | ACP had lower mortality in the long term, and ACP was preferred over the RCP method |
| Stamou 2016 (13) | ACP vs. RCP | ACP and RCP both are safe methods for brain protection |
| Apostolakis 2008 (14) | ACP vs. RCP | ACP had a lower incidence rate of TND and shorter ICU-stay time. ACP and RCP both had almost similar mortality rates |
| Wiedemann 2013 (21) | ACP/HCA vs. RCP/HCA | The ACP group had a longer three and five-year survival rate than the RCP |
| uACP/HCA vs. bACP/HCA | Both uACP and bACP groups had similar mortality rates | |
| Tokuda 2014 (20) | ACP/HCA vs. RCP/HCA | ACP and RCP groups had the same mortality rate and neurologic complications |
| Sun 2021 (9) | ACP vs. RCP | The ACP group had a higher PND incidence rate compared to RCP, and the mortality rate between the groups was almost equal |
| Samanidis 2021 (17) | ACP/MHCA vs. RCP/DHCA | Both ACP and RCP had equivalent rates of early mortality, ICU-stay, and incidence of PND |
| Sugiura 2012 (19) | ACP/MHCA vs. RCP/MHCA | ACP group had no advantage over RCP. Both groups had equivalent rates of early mortality and PND |
| Sinatra 2001 (18) | ACP/DHCA vs. RCP/DHCA | Mortality and neurologic complications were not significant between the groups |
| O’Hara 2020 (27) | ACP vs. RCP | Mortality between the groups was not significant |
| Montagner 2022 (16) | uACP vs. bACP vs. RCP | Operation time in the RCP group was longer compared to other groups. uACP, bACP, and RCP methods were safe and equivalent in terms of mortality and neurologic complications |
| Benedetto 2021 (15) | uACP/DHCA vs. bACP/DHCA vs. RCP/DHCA | uACP and bACP were preferred over DHCA alone |
| Tong 2017 (25) | uACP vs. bACP | bACP had no advantage over uACP in terms of mortality and PND incidence |
| Angleitner 2020 (29) | uACP vs. bACP | bACP had better overall survival compared to uACP |
| Norton 2020 (28) | uACP vs. bACP | uACP and bACP had almost the same results in terms of mortality and stroke. However, uACP was a simple method and less complicated compared to bACP |
| Song 2022 (30) | uACP vs. bACP | There were no significant changes between the two groups in mortality, PND and TND |
| Inamura 2006 (26) | uACP vs. bACP | No significant changes between uACP and bACP in PND, TND and mortality (P value >0.05) |
| Piperata 2022 (35) | uACP/MHCA vs. bACP/MHCA | uACP and bACP had no differences in mortality and TND. While bACP had a higher incidence rate of PND. uACP is suggested when considering all limitations |
| Jiang 2023 (34) | uACP vs. bACP | bACP had a lower incidence of PND and mortality compared to uACP |
| Krüger 2011 (4) | uACP vs. bACP | bACP had a higher incidence of PND and mortality than the bACP group |
| Preventza 2015 (33) | uACP vs. bACP | uACP is preferred for its less complicated Technique. Both groups had the same rates of mortality and TND |
| Liu 2020 (32) | uACP vs. bACP | bACP had a lower incidence of PND and TND, while no significant changes were observed in mortality |
| Dong 2020 (31) | uACP/MHCA vs. bACP/MHCA | Both groups had almost same incidence of PND, TND and mortality (P value >0.05) |
ACP, antegrade cerebral perfusion; RCP, retrograde cerebral perfusion; CPB, cardiopulmonary bypass; TND, transient neurologic deficit; ICU, intensive care unit; HCA, hypothermic circulatory arrest; uACP, unilateral antegrade cerebral perfusion; bACP, antegrade bilateral cerebral perfusion; PND, permanent neurologic dysfunction; MHCA, moderate hypothermic circulatory arrest; DHCA, deep hypothermic circulatory arrest.