title: Long-term comparison of aortic arch replacement with or without elephant trunk procedure via retrograde cerebral perfusion for aortic arch dissection.
abstract: OBJECTIVE
  The aim of this study is to investigate the effects of the duration of retrograde cerebral perfusion (RCP) in patients with aortic arch dissection.
  
  
  METHODS
  Between 1993 and December 2000, 56 patients were operated on for aortic arch dissection. Elephant trunk procedure was performed in 28 patients (Group A) and semiarcus replacement in 28 patients (Group B). Type I dissection (P=0.003), chronic ethiology (P=0.006), medial degeneration (P<0.001), and preoperative hemodynamic instability (P=0.004) were observed significantly more in Group A. In both groups RCP was used for cerebral protection.
  
  
  RESULTS
  Hospital mortality was higher in Group A than Group B (32.1% versus 7.1%; P=0.015). Late mortality was observed only in Group A (10.5%; P=0.049). Actuarial survival was 55.1+/-11.55% in Group A and 91.67+/-5.64% in Group B at 5 yr (P=0.0113), while cumulative survival for all patients was 78.38+/-5.77% at 5 yr. RCP time was longer in Group A (62.7+/-16.8 versus 34.2+/-19.5 min; P<0.001). Forward stepwise logistic regression analysis showed that chronic obstructive pulmonary disease (P=0.014) and renal insufficiency (P=0.004) were significantly predictors for hospital mortality, whereas elephant trunk (P=0.052) and RCP (>60 min) (P=0.175) did not increase early mortality. Only hemodynamic instability was significantly (P=0.006) predictors for late mortality.
  
  
  CONCLUSIONS
  Preoperative severity of dissection, hemodynamic instability or organ dysfunctions impair early or late outcome. Elephant trunk technique with increased RCP time do not increase early or late mortality. To shorten RCP time (<60-65 min) can improve surgical results.
authors.affiliation: Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com
authors.forename: Kaan
authors.initials: K
authors.lastname: Kirali
authors.forename: Suat N
authors.initials: SN
authors.lastname: Omeroğlu
authors.forename: Hasan
authors.initials: H
authors.lastname: Ardal
authors.forename: Mehmet E
authors.initials: ME
authors.lastname: Toker
authors.forename: Hasan B
authors.initials: HB
authors.lastname: Erdoğan
authors.forename: Bahadir
authors.initials: B
authors.lastname: Dağlar
authors.forename: Mehmet
authors.initials: M
authors.lastname: Balkanay
authors.forename: Gökhan
authors.initials: G
authors.lastname: Ipek
authors.forename: Omer
authors.initials: O
authors.lastname: Işik
authors.forename: Cevat
authors.initials: C
authors.lastname: Yakut
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000401:mortality; D010477:Perfusion / Q000379:methods; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods