Impact of retrograde cerebral perfusion with posterolateral thoracotomy on distal arch aneurysm repair.
BACKGROUND
Repair of distal aortic arch aneurysms is difficult to accomplish through a median sternotomy or left thoracotomy, and stroke and respiratory disorders often become lethal complications with the use of circulatory arrest. We investigated the use of retrograde cerebral perfusion with a posterolateral thoracotomy in the repair of distal arch aneurysms.


METHODS
Thirty-eight patients underwent repair of a distal arch aneurysm. They were divided into three groups according to the method of surgical repair used. Sixteen patients (group I) underwent proximal anastomosis of the graft with the use of an aortic cross-clamp. Eight patients (group II) underwent open proximal anastomosis with the use of retrograde cerebral perfusion (oxygenated blood perfusion through a superior vena cava cannula) and a median sternotomy and anterolateral thoracotomy. Fourteen patients (group III) also underwent open anastomosis with the use of retrograde cerebral perfusion (cerebral perfusion through blood returned to the right atrium with the patient in the Trendelenburg position) and a posterolateral thoracotomy.


RESULTS
The operative mortality rate in group I was 25.0%; 4 of 16 patients died of stroke, myocardial infarction, and intestinal necrosis. In group II, 3 of 8 patients (37.5%) died of respiratory failure and aortic dissection. In group III, only 1 of 14 patients (7.1%) died, as a result of heart failure.


CONCLUSIONS
The use of retrograde cerebral perfusion with a posterolateral thoracotomy is an alternative method that minimizes the risk of stroke and respiratory failure during distal aortic arch operations.
Yamashita
C
C
Department of Surgery, Kobe University School of Medicine, Japan.
Okada
M
M
Yoshimura
T
T
Azami
T
T
Nakagiri
K
K
Wakiyama
H
H
Ataka
K
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D000784:Aortic Dissection / Q000209:etiology; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D002303:Cardiac Output, Low / Q000209:etiology; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D002423:Cause of Death; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects; D006325:Heart Atria; D006801:Humans; D007422:Intestines / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D009336:Necrosis; D011183:Postoperative Complications; D012131:Respiratory Insufficiency / Q000209:etiology; D012307:Risk Factors; D015996:Survival Rate; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D014683:Vena Cava, Superior