title: Aortic arch replacement using selective cerebral perfusion.
abstract: BACKGROUND
  The present study was conducted to report our clinical experience with aortic arch replacement using selective cerebral perfusion (SCP) and determine the independent predictors of in-hospital mortality and neurologic outcome.
  
  
  METHODS
  We studied 472 consecutive patients who underwent aortic arch replacement using SCP between January 1986 and February 2006. All operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and in most cases, systemic circulatory arrest for open distal anastomosis. The etiology of aortic diseases included acute aortic dissection in 126 patients (27%), chronic aortic dissection in 102 (21%), and degenerative aneurysm in 245 (52%). Total arch replacement was performed in 420 patients (89%). Mean SCP time was 88 +/- 32 minutes.
  
  
  RESULTS
  The overall in-hospital mortality was 9.3%, but it dropped significantly to 4.1% in the most recent 266 patients. Independent predictors of in-hospital mortality were early series, renal/mesenteric ischemia, pump time, increasing age, chronic renal dysfunction, history of cerebrovascular accident (CVA), and previous ascending or arch operation. Overall postoperative temporary and permanent neurologic dysfunction were 4.7% and 3.2%, respectively. A history of CVA was the only predictor of temporary neurologic dysfunction, whereas CVA and pump time were independent predictors of permanent neurologic dysfunction. SCP time had no significant correlation with in-hospital mortality and neurologic outcome.
  
  
  CONCLUSIONS
  SCP facilitates complicated aortic arch replacement, resulting in a reduction of mortality and morbidity for arch aneurysms or dissections.
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. tkazui@hama-med.ac.jp
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Kazui
authors.forename: Katsushi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Naoki
authors.initials: N
authors.lastname: Washiyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Terada
authors.forename: Abul Hasan Muhammad
authors.initials: AH
authors.lastname: Bashar
authors.forename: Kazuchika
authors.initials: K
authors.lastname: Suzuki
authors.forename: Takayasu
authors.initials: T
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D001921:Brain / Q000098:blood supply*; D005260:Female; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D010477:Perfusion / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000150:complications; D013997:Time Factors