Medium-term results after surgery for aortic arch aneurysm with hypothermic cerebral perfusion

• Published in: European journal of cardio-thoracic surgery Vol. 9; no. 12; pp. 697 - 700
• Main Authors: KITAMURA, M, HASHIMOTO, A, AOMI, S, IMAMAKI, M, KOYANAGI, H
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 1995; Elsevier Science
• Subjects: Actuarial Analysis; Adult; Aged; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - surgery; Aortic Valve - surgery; Biological and medical sciences; Blood Pressure; Blood Vessel Prosthesis; Cardiopulmonary Bypass; Cause of Death; Cerebrovascular Circulation; Female; Follow-Up Studies; Heart Arrest, Induced; Humans; Hypothermia, Induced - methods; Intraoperative Care; Male; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; Time Factors; Dissecting aneurysm; Human; Perfusion; Aortic arch; Aneurysm; Aorta; Brain (vertebrata); Hypothermia
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(05)80128-9

We have used two techniques of hypothermic cerebral perfusion (CP) forthe surgical treatment of aortic arch aneurysm in the last 10 years.Between March 1985 and December 1993, 83 patients underwent surgery foraortic arch aneurysm. Fifty-one cases had aortic dissection (AD) in thetransverse arch and/or its branches, and 32 cases showed true aneurysm (TA)of the aortic arch. In those 83 patients, 37 cases received antegrade CPand 46 cases underwent retrograde CP. Surgical results were compared amongthe groups by Kaplan-Meier actuarial method and Cox- Mantel statisticalanalysis. The early mortality after surgery for aortic arch aneurysm was11.8% in the AD group and 21.9% in the TA group. The early mortality was21.6% with antegrade CP and 10.9% with retrograde CP. The 6-year actuarialsurvival rate was 71.7% in the TA group and 67.1% in the AD group. In theAD group, the 3-year survival rate was 93.9% with retrograde CP and 61.1%with antegrade CP (P < 0.005). In the TA group, the 3-year survival ratewas similar for antegrade CP (73.3%) and retrograde CP (69.2%). Theseresults suggest that current surgical results of aortic arch aneurysm withhypothermic CP are acceptable and the retrograde CP technique might berecommended, especially for surgery of aortic arch aneurysm with AD.