Total aortic arch grafting via median sternotomy using integrated antegrade cerebral perfusion.
BACKGROUND
In aortic arch grafting, antegrade cerebral perfusion prolongs the safe time of arch exclusion. However, there are the problems of cerebral embolism and distribution of the cerebral perfusion. We describe and analyze mortality and cerebral complications in patients undergoing total arch grafting using our refined technique.


METHODS
Between June 1994 and March 2002, 100 consecutive patients underwent total arch grafting through median sternotomy. There were 49 atherosclerotic aneurysms and 51 aortic dissections. Fifty-four patients were operated on an emergency basis because of rupture or acute type A dissection. We conducted total arch grafting using hypothermic antegrade cerebral perfusion from every cervical vessel. Carbon dioxide gas was added to the cerebral perfusion in order to inhibit the increase in the cerebral vascular resistance during hypothermic cerebral perfusion.


RESULTS
Hospital mortality was 4%. The causes of death were dysarrhythmia (n = 1), mesenteric necrosis (n = 1), and preoperative cardiac arrest (n = 2). On univariate analysis, preoperative shock and concomitant cardiac procedures were risk factors for hospital death. The rate of postoperative neurologic damage was 5%. Two patients suffered from cerebral infarction. Temporary neurologic dysfunction occurred in 3 patients. On univariate analysis, emergency surgery was a risk factor for postoperative neurologic damage. On multivariate analysis, there was no significant independent predictor of hospital mortality and neurologic damage. Actuarial survival at 96 months was 66.4 +/- 9.1%, and freedom from aortic accidents (reoperation, rupture, and cholesterol embolism) was 74.9 +/- 7.9%.


CONCLUSIONS
The early- and long-term results of total arch grafting using integrated antegrade cerebral perfusion were found to be satisfactory.
Takahara
Yoshiharu
Y
Division of Cardiovascular Surgery, Funabashi Municipal Medical Center, Chiba, Japan. yosh193@attglobal.net
Mogi
Kenji
K
Sakurai
Manabu
M
Nishida
Hirohumi
H
D000368:Aged; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D005112:Extracorporeal Circulation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D013249:Sternum / Q000601:surgery; D020521:Stroke / Q000517:prevention & control*; D016019:Survival Analysis; D013908:Thoracotomy / Q000379:methods; D016896:Treatment Outcome