Risk analysis for aortic surgery using hypothermic circulatory arrest with retrograde cerebral perfusion.
BACKGROUND
Retrospective analysis of 144 patients undergoing aortic arch reconstruction using hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP) for cerebral protection was performed.


METHODS
The diagnosis, procedure, and anatomic site of the arch anastomosis were analyzed to see if they were independent predictors of mortality or morbidity. In addition age, gender, HCA-RCP times, preoperative malperfusion (both treated and untreated), surgical status, and redo surgery status were also examined to determine their influence on the incidence of death and complications. Both multivariate and univariate analysis were performed using linear regression and cross-tabulation with either chi2 or Fisher's exact test where appropriate.


RESULTS
Preoperative surgical status (emergent) and the presence of untreated preoperative malperfusion were the only variables that were significant independent predictors for mortality (p <0.05). No variable was significant for the prediction of stroke or other complications. The severity of surgery had no bearing on the patient outcome.


CONCLUSIONS
Complex aortic surgery using HCA-RCP can be performed with acceptable risk to the patients.
Deeb
G M
GM
Department of Surgery, University of Michigan Health Systems, Ann Arbor 48109-0348, USA. mdeeb@umich.edu
Williams
D M
DM
Quint
L E
LE
Monaghan
H M
HM
Shea
M J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002561:Cerebrovascular Disorders / Q000517:prevention & control; D017558:Elective Surgical Procedures; D004630:Emergencies; D005112:Extracorporeal Circulation / Q000379:methods*; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis