title: Impact of retrograde cerebral perfusion on ascending aortic and arch aneurysm repair.
abstract: OBJECTIVE
  The effect of retrograde cerebral perfusion on the incidence of stroke and death among patients undergoing repair of aneurysms of the ascending aorta and transverse arch was determined.
  
  
  METHODS
  Between January 1991 and March 1995, 161 patients were operated on for aneurysms of the ascending aorta and transverse arch. Thirty-three of the patients (20%) had an aneurysm of the ascending aorta only and 128 (80%) had aneurysms of both the ascending aorta and the transverse arch. All the patients underwent cardiopulmonary bypass, profound hypothermia, and circulatory arrest, and 120 (74%) also underwent retrograde cerebral perfusion. Median pump time was 143 minutes (range, 21 to 461 minutes). Median circulatory arrest time was 42 minutes (range, 8 to 111 minutes), and median myocardial ischemic time was 71 minutes (range, 14 to 306 minutes).
  
  
  RESULTS
  The overall 30-day mortality rate was 6% (9 patients) and the incidence of stroke was 4% (7 patients). The use of retrograde cerebral perfusion demonstrated a protective effect against stroke (3 of 120 patients, or 3%) compared with no retrograde cerebral perfusion (4 of 41 patients, or 9%; odds ratio, 0.24; confidence interval, 0.06 to 0.99; p < 0.049). This was most significant in patients more than 70 years of age; none of the 36 elderly patients who received retrograde cerebral perfusion had a stroke, compared with 3 of the 13 (23%) who did not (p < 0.003). Only pump time was associated with an increased risk of stroke (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.005). Pump time also was associated with increased mortality (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.008).
  
  
  CONCLUSIONS
  Retrograde cerebral perfusion decreased the incidence of stroke in patients undergoing repair of aneurysms of the ascending aorta and transverse arch.
authors.affiliation: Department of Surgery, Baylor College of Medicine, The Methodist Hospital, Houston, Texas, USA.
authors.forename: H J
authors.initials: HJ
authors.lastname: Safi
authors.forename: G V
authors.initials: GV
authors.lastname: Letsou
authors.forename: D C
authors.initials: DC
authors.lastname: Iliopoulos
authors.forename: M H
authors.initials: MH
authors.lastname: Subramaniam
authors.forename: C C
authors.initials: CC
authors.lastname: Miller
authors.forename: H
authors.initials: H
authors.lastname: Hassoun
authors.forename: P J
authors.initials: PJ
authors.lastname: Asimacopoulos
authors.forename: J C
authors.initials: JC
authors.lastname: Baldwin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001014:Aortic Aneurysm / Q000401:mortality / Q000628:therapy*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000628:therapy; D002315:Cardiopulmonary Bypass; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000517:prevention & control*; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015424:Reperfusion / Q000379:methods*; D015996:Survival Rate