Brain protection using antegrade selective cerebral perfusion: a multicenter study.
BACKGROUND
To evaluate the results of antegrade selective cerebral perfusion as a method of brain protection during surgery of the thoracic aorta and to determine predictors of hospital mortality and adverse neurologic outcome.


METHODS
Between October 1995 and March 2002, 588 patients underwent aortic surgery with the aid of antegrade selective cerebral perfusion. There were 334 men (56.8%); the mean age was 63.7 +/- 11.8 years. One hundred sixty-two patients (27.6%) underwent urgent operation. The separated graft technique was employed to reimplant the arch vessels in 230 patients (65.3%) of the 352 requiring aortic arch replacement. Associated procedures were performed in 254 patients (43.2%). One hundred twelve patients underwent elephant trunk procedure. The mean cerebral perfusion time was 67 +/- 37 minutes.


RESULTS
The overall hospital mortality rate was 8.7%. A logistic regression analysis revealed urgent operation, recent central neurologic event, tamponade, unplanned coronary artery revascularization and pump time to be independent predictors of hospital mortality (p < 0.05). The permanent neurologic dysfunction rate was 3.8%. A logistic regression analysis showed tamponade to be independent predictor of permanent neurologic dysfunction (p < 0.05). The transient neurologic dysfunction rate was 5.6%. Recent central neurologic event, tamponade, coronary disease, and aortic valve replacement were indicated as independent predictors of transient neurologic dysfunction by logistic regression (p < 0.05).


CONCLUSIONS
In our experience the utilization of antegrade selective cerebral perfusion resulted in encouraging results in terms of hospital mortality and brain complications. Neither the extent of the replacement nor the duration of the cerebral perfusion had an impact on hospital mortality and neurologic outcome.
Di Eusanio
Marco
M
Department of Cardiopulmonary Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. m_dieus@hotmail.com
Schepens
Marc A A M
MA
Morshuis
Wim J
WJ
Dossche
Karl M
KM
Di Bartolomeo
Roberto
R
Pacini
Davide
D
Pierangeli
Angelo
A
Kazui
Teruhisa
T
Ohkura
Kazuhiro
K
Washiyama
Naoki
N
D001013:Aorta, Thoracic / Q000601:surgery*; D001921:Brain / Q000502:physiology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications; D012307:Risk Factors; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality