Surgery for acute type A dissection using antegrade selective cerebral perfusion: experience with 122 patients.
BACKGROUND
Antegrade selective cerebral perfusion (ASCP) has proved to be a reliable method of brain protection during surgery of the thoracic aorta, but its use during aortic dissection surgery still remains controversial. In this study, we present our results after the operative repair of acute type A aortic dissections using ASCP and moderate hypothermic circulatory arrest.


METHODS
Between October 1995 and August 2001, 122 patients (76 men, 46 women) underwent repair of acute type A aortic dissection with the aid of ASCP and open distal anastomosis. The average age of the patients was 61 +/- 12 (mean +/- standard deviation). Preoperative complications included cardiac tamponade (n = 34; 27.0%), aortic regurgitation (n = 27; 22.1%), and new neurological deficits (n = 11; 9%).


RESULTS
Stepwise logistic regression revealed preoperative cardiac tamponade (p = 0.018) and new neurological deficits (p = 0.017) to be independent determinants for hospital mortality (19.7%). Permanent neurological complications occurred in 7% of the patients. Independent risk factors for temporary neurological dysfunction (11.2%) included cardiac tamponade (p = 0.019) and preoperative neurological deficits (p = 0.000).


CONCLUSIONS
In our experience, the surgical treatment of acute type A aortic dissection with the aid of ASCP was associated with acceptable hospital mortality and neurologic morbidity rates.
Di Eusanio
Marco
M
Department of Cardiopulmonary Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. m_dieus@hotmail.com
Tan
M Erwin S H
ME
Schepens
Marc A A M
MA
Dossche
Karl M
KM
Di Bartolomeo
Roberto
R
Pierangeli
Angelo
A
Morshuis
Wim J
WJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006324:Heart Arrest, Induced; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors