title: Operations on the thoracic aorta and antegrade selective cerebral perfusion: our experience with 462 patients.
abstract: 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.
authors.affiliation: Department of Cardiovascular Surgery, G M Lancisi Hospital, Ancona, Italy. m_dieus@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Marc
authors.initials: M
authors.lastname: Schepens
authors.forename: Wim
authors.initials: W
authors.lastname: Morshuis
authors.forename: Karl
authors.initials: K
authors.lastname: Dossche
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Luca
authors.initials: L
authors.lastname: Di Marco
authors.forename: Angelo
authors.initials: A
authors.lastname: Pierangeli
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: 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