Operations on the thoracic aorta and antegrade selective cerebral perfusion: our experience with 462 patients.
BACKGROUND
We retrospectively analyzed the hospital mortality and neurologic outcome after surgery on the thoracic aorta with the aid of antegrade selective cerebral perfusion to determine a predictive risk model.


METHODS
Between October 1995 and May 2002, 462 patients (mean age 62.7 +/- 11.7 years) underwent surgery on the thoracic aorta using antegrade selective cerebral perfusion. The indication for surgery was acute type A dissection in 132 patients (28.6%), degenerative aneurysm in 258 (55.8%), and post-dissection aneurysm in 72 (15.6%). One hundred and forty-one patients (30.5%) were operated on urgently; concomitant procedures were performed in 190 patients (41.1%). The mean cerebral perfusion time was 63 +/- 39 min. Predictors of hospital mortality and neurologic outcome were identified by univariate and multivariate analysis of the preoperative and intraoperative variables.


RESULTS
The hospital mortality rate was 10.2%. Stepwise logistic regression identified an urgency status (odds ratio--OR 5.2, p = 0.001), a history of a central neurologic event (OR 4.1, p = 0.007) and coronary artery bypass graft (OR 3.2, p = 0.039) as being independent determinants for hospital mortality. The transient neurologic dysfunction rate was 6.2%. An urgency status (OR 3.4, p = 0.003) and a history of a central neurologic event (OR 5.1, p = 0.002) were independent determinants of transient neurologic dysfunction. An urgency status (OR 6.0, p = 0.011) was the only independent determinant for permanent neurologic dysfunction (3.8%). A cerebral perfusion time > 90 min was not associated with an increased risk of hospital mortality and permanent or transient neurologic dysfunction.


CONCLUSIONS
Antegrade selective cerebral perfusion proved to be a safe method of brain protection allowing complex aortic repair to be performed with encouraging results in terms of hospital mortality and neurologic outcome.
Di Eusanio
Marco
M
Department of Cardiovascular Surgery, G M Lancisi Hospital, Ancona, Italy. m_dieus@hotmail.com
Schepens
Marc
M
Morshuis
Wim
W
Dossche
Karl
K
Pacini
Davide
D
Di Marco
Luca
L
Pierangeli
Angelo
A
Di Bartolomeo
Roberto
R
D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D002532:Intracranial Aneurysm / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D010477:Perfusion; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome