Usefulness of antegrade selective cerebral perfusion during aortic arch operations.
BACKGROUND
To evaluate the safety and usefulness of antegrade selective cerebral perfusion (SCP) during arch aneurysm or aortic dissection operations.


METHODS
Between January 1986 and December 2001, 330 patients underwent aortic arch repair using SCP. Operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and systemic circulatory arrest in most cases. In all, 89 patients (27%) were operated on for acute aortic dissection, 77 (23%) for chronic aortic dissection, and 164 (50%) for degenerative aneurysm. Total arch replacement using a branched graft was performed in 288 patients (94%). Mean SCP time was 86.2 +/- 28.5 minutes.


RESULTS
The overall in-hospital mortality rate was 11.2% (falling to 3.2% in the 124 patients operated on between 1997 and 2001). Independent determinants of hospital mortality were pump time, renal/mesenteric ischemia, chronic renal failure, increasing age, period of operation, and nonuse of four-branched arch graft. The overall postoperative incidences of temporary and permanent neurologic dysfunction were 4.2% and 2.4%, respectively. There was no significant correlation between SCP time and in-hospital mortality or neurologic outcome.


CONCLUSIONS
Selective cerebral perfusion is a reliable technique for cerebral protection and it facilitates complex and time-consuming total arch replacement.
Kazui
Teruhisa
T
First Department of Surgery, Hamamatsu University School of Medicine, Japan. tkazui@hama-med.ac.jp
Yamashita
Katsushi
K
Washiyama
Naoki
N
Terada
Hitoshi
H
Bashar
Abul Hasan Muhammad
AH
Suzuki
Takayasu
T
Ohkura
Kazuhiro
K
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000401:mortality / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality / Q000517:prevention & control*; D008297:Male; D010477:Perfusion; D012307:Risk Factors; D015996:Survival Rate