Results of aortic arch repair with hypothermic circulatory arrest and retrograde cerebral perfusion.
BACKGROUND
Repair of aortic arch pathology is reliably performed with hypothermic circulatory arrest, but the best method of brain protection is controversial.


METHODS
We reviewed a consecutive series of 67 patients who had aortic arch repair with hypothermic circulatory arrest. Retrograde perfusion of arterial blood into the superior vena cava (SVC) during systemic arrest was used in 87%. Average age was 65 years. Acute dissection was present in 25%. Average circulatory arrest time was 37 minutes, and average temperature 17.7 degrees C.


RESULTS
Hospital mortality was 1.5%. Strokes occurred in 4.5%. Temporary neurological dysfunction occurred in 16%. Multivariate logistic regression analysis showed that acute dissection was the only independent predictor of the combined risk of stroke and temporary neurological dysfunction (odds ratio 8.5). Duration of circulatory arrest and patient age were not risk factors for adverse neurological outcome.


CONCLUSIONS
Continuous arterial perfusion of the SVC during hypothermic circulatory arrest provides excellent cerebral protection for aortic arch repair. Acute dissection is an independent risk factor for adverse neurological outcome. Arrest time is not a predictor of neurological dysfunction.
Hilgenberg
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AD
Thoracic Aortic Center and Department of Surgery, Massachusetts General Hospital, Boston 02114, USA.
Logan
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DL
D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D007430:Intraoperative Care; D008297:Male; D009422:Nervous System Diseases / Q000453:epidemiology; D010477:Perfusion; D015427:Reperfusion Injury / Q000517:prevention & control*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology