Usefulness of antegrade selective cerebral perfusion during aortic arch operations

• Published in: The Annals of thoracic surgery Vol. 74; no. 5; pp. S1806 - S1809
• Main Authors: Kazui, Teruhisa, Yamashita, Katsushi, Washiyama, Naoki, Terada, Hitoshi, Bashar, Abul Hasan Muhammad, Suzuki, Takayasu, Ohkura, Kazuhiro
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.11.2002; Elsevier Science
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Biological and medical sciences; Brain - blood supply; Brain Ischemia - mortality; Brain Ischemia - prevention & control; Cardiopulmonary Bypass; Cause of Death; Female; Hospital Mortality; Humans; Intraoperative Complications - mortality; Intraoperative Complications - prevention & control; Male; Medical sciences; Perfusion; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Survival Rate; 26; Human; Prevention; Nervous system diseases; Aorta arch; Perfusion; Anterograde; Surgery; Central nervous system disease; Technique; Brain (vertebrata)
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/S0003-4975(02)04150-4

To evaluate the safety and usefulness of antegrade selective cerebral perfusion (SCP) during arch aneurysm or aortic dissection operations. Between January 1986 and December 2001, 330 patients underwent aortic arch repair using SCP. Operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and systemic circulatory arrest in most cases. In all, 89 patients (27%) were operated on for acute aortic dissection, 77 (23%) for chronic aortic dissection, and 164 (50%) for degenerative aneurysm. Total arch replacement using a branched graft was performed in 288 patients (94%). Mean SCP time was 86.2 ± 28.5 minutes. The overall in-hospital mortality rate was 11.2% (falling to 3.2% in the 124 patients operated on between 1997 and 2001). Independent determinants of hospital mortality were pump time, renal/mesenteric ischemia, chronic renal failure, increasing age, period of operation, and nonuse of four-branched arch graft. The overall postoperative incidences of temporary and permanent neurologic dysfunction were 4.2% and 2.4%, respectively. There was no significant correlation between SCP time and in-hospital mortality or neurologic outcome. Selective cerebral perfusion is a reliable technique for cerebral protection and it facilitates complex and time-consuming total arch replacement.