Comparative study of cerebral protection during surgery of thoracic aortic aneurysm.
During the past 5 years, 30 cases of thoracic aortic aneurysm were treated. Selective cerebral perfusion (SCP) and retrograde cerebral perfusion (RCP) were conducted for cerebral protection during aortic cross clamping. SCP was carried out in 5 cases of dissecting aneurysm (all Stanford type A, including a case of AAE) and 3 cases of arch aneurysm. RCP was conducted in 5 cases of dissecting aneurysm (4 Stanford type A, 1 Stanford type B with retrograde dissection) and 2 cases of aortic arch aneurysm. The mean cerebral perfusion time of SCP exceeded that of RCP (89 +/- 26 min in SCP versus 61 +/- 33 min in RCP p < 0.05). The hospital mortality rate was 38% (SCP) and 29% (RCP). Neurological complications were prolonged unconsciousness (1/8 in SCP, 1/7 in RCP) and transient paralysis (0/8 in SCP, 1/7 in RCP). Although the mechanism for the cerebral protective effect of RCP is unknown, this perfusion method is easy and safe, requiring little time for ascending and/or arch aortic reconstruction.
Sueda
T
T
First Department of Surgery, Hiroshima University School of Medicine, Japan.
Nomimura
T
T
Kagawa
T
T
Morita
S
S
Hayashi
S
S
Orihashi
K
K
Shikata
H
H
Ryuu
G
G
Hamanaka
Y
Y
Matsuura
Y
Y
D000368:Aged; D017545:Aortic Aneurysm, Thoracic / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D010477:Perfusion / Q000379:methods