[Effect of antegrade brain perfusion on neurogical complications after surgical treatment of aneurysm and dissection with circulatory arrest].
From January 2001 until December 2003 twenty patients have been operated for acute or chronic dissection with involvement of the aortic arch. 16 of them were men, and 4--women, with middle age of 57 years. Two methods of cerebral perfusion have been used--hypothermic circulatory arrest (HCA) or selective antegrade cerebral perfusion (ACP). Direct cannulation or suturing of vascular prosthesis to the brachiocephalic trunk has been used for ACP. Twelve (12) partial and 8 total arch replacements have been done. The duration of ACP (54 min.) is longer than the time of HCA (32 min.). The neurological postoperative complications--coma (7.6%) and ischemic encephalopathy (30.4%), were significantly lower in the group with ACP than in the group of the HCA--14.2% and 42.6% respectively. Overall mortality is 15%--3 patients dying after the 30th day. Preoperative hemodynamic instability and neurological symptoms are strongly related with postoperative neurological complications. The method of cerebral protection did not influence the mortality, but the postoperative neurological complications are significantly lower in the group with ACP. We recommend ACP in all cases of acute aortic dissection and all aneurisms with arch involvement needing extended surgical operation.
Baev
B
B
Nachev
G
G
Petkov
D
D
Iakimov
T
T
Chirkov
A
A
D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001921:Brain / Q000098:blood supply*; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control; D002560:Cerebrovascular Circulation; D003128:Coma / Q000209:etiology / Q000517:prevention & control; D005260:Female; D006324:Heart Arrest, Induced / Q000379:methods*; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000401:mortality