Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome.
OBJECTIVE
Although cannulation of the femoral artery is used routinely for thoracic aortic operations with hypothermic circulatory arrest, retrograde perfusion through the descending aorta carries the risk of cerebral malperfusion or embolism. We have, therefore, routinely used a central cannulation technique for distal arch and descending aortic operations since 1995. In this study, we compared neurological outcome in consecutive patients undergoing femoral versus ascending aortic perfusion for these aneurysms.


METHODS
Between 1987 and 1998, 61 patients underwent aortic resection with circulatory arrest, but without retrograde cerebral perfusion, for lesions of the aortic arch and descending aorta. Thirty-one patients had fusiform true aneurysms, 19 had aortic dissection and 11 had extensive saccular or false aneurysms. Thirty-two patients (52%) were perfused via the femoral artery (group A), and 29 patients (48%) from the ascending aorta (group B). Operative mortality and morbidity, and neurological outcome, were reviewed.


RESULTS
There were no differences between the groups in mean age, pathology, abdominal and peripheral vascular disease, net perfusion time, or circulatory arrest time. There were four hospital deaths (three in group A and one in group B; P = 0.61), including one neurological death in group A, group A suffered a higher incidence of neurological events (nine patients: 28%) than group B (two patients: 7%; P = 0.03). Temporary focal neurological deficits occurred in both groups (two patients in group A, 6% and two patients in group B, 7%; P > 0.99), but permanent injury occurred exclusively in group A (seven patients: four with monoplegia, one with hemiplegia, and two with diffuse cerebral injury with one death; P = 0.01).


CONCLUSIONS
Anterograde perfusion using a proximal aortic cannula provides a low risk of cerebral embolism and allows extensive aortic resection with low morbidity.
Westaby
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Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, Headington, UK.
Katsumata
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Vaccari
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery; D017542:Aneurysm, Ruptured / Q000401:mortality / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D002545:Brain Ischemia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D015994:Incidence; D002542:Intracranial Embolism and Thrombosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*