Experience with cerebral perfusion in total aortic arch replacement.
BACKGROUND
The interruption of cerebral circulation is a major problem in the surgical repair of the aortic arch. This study was undertaken to identify the perioperative risk factors for mortality and neurological morbidity, and the outcome after total aortic arch replacement.


METHODS
Between June 1995 and March 2002, 23 patients (13 males) underwent total aortic arch replacement. The mean age was 61.7I9.4 years (range 35-77). All patients underwent total arch replacement with a period of hypothermic circulatory arrest (HCA). Selective cerebral perfusion was utilized as an adjunct to HCA (retrograde in 19 patients and antegrade in 4 patients). The elephant trunk technique was used in 18 patients, while proximal and middle portion of the descending aorta was also replaced in 5 patients. The patient information in our database was retrospectively reviewed. The risk factors affecting mortality and morbidity were analyzed by univariate analysis.


RESULTS
The in-hospital mortality rate was 17.4%. None of the survivors developed major stroke. Temporary neurological dysfunction (TND) was seen in 5 patients. Univariate analysis revealed that excessive blood transfusion was the only factor correlated with hospital death among 18 perioperative variables (p<0.006). HCA lasting > 55 minutes and a history of hypertension were associated with the development of TND (p<0.032 and p<0.02, respectively).


CONCLUSIONS
Total arch replacement can be performed with acceptable mortality and neurological morbidity. Midterm survival is excellent in hospital survivors. The duration of HCA is not associated with in-hospital mortality when selective cerebral perfusion (either antegrade or retrograde) is used as an adjunct.
Apaydin
Anil Z
AZ
Department of Cardiovascular Surgery, Ege University Medical School, Izmir, Turkey. apaydina@efes.net.tr
Islamoglu
Fatih
F
Iyem
Hikmet
H
Posacioglu
Hakan
H
Yagdi
Tahir
T
Büket
Suat
S
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery; D002560:Cerebrovascular Circulation; D005260:Female; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality