Antegrade cerebral perfusion for acute type A aortic dissection in 120 consecutive patients.
BACKGROUND
Treatment of acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurologic morbidity and mortality. The following study investigates clinical results after modification of perfusion technique for cardiopulmonary bypass as well as temperature management.


METHODS
Between January 2000 and August 2006, 120 consecutive patients underwent repair of acute type A dissection. Selective antegrade cerebral perfusion through the right subclavian artery combined with mild systemic hypothermia (30 degrees C) was used in all patients.


RESULTS
Mean cardiopulmonary bypass time was 144 +/- 53 minutes, and mean myocardial ischemic time was 98 +/- 49 minutes. Isolated cerebral perfusion was performed for 25 +/- 12 minutes. Mean core temperature amounted to 30.1 degrees +/- 2.2 degrees C. Chest tube drainage during the first 24 hours was 525 +/- 220 mL. Mean ventilation time was 54 +/- 22 hours. Elevation of serum lactate levels at 1, 12, and 24 hours postoperatively rose to 22 +/- 14, 18 +/- 11, and 19 +/- 8 mg/dL respectively. We observed new postoperative permanent neurologic deficits in 5 patients (4.2%) and TND in 3 patients (2.5%). The 30-day mortality rate was 5% (n = 6). After a mean follow-up period of 2.8 years, 104 patients (87%) were still alive.


CONCLUSIONS
Antegrade cerebral perfusion in combination with mild hypothermia offered sufficient neurologic protection in our patient cohort, provided adequate distal organ protection, and reduced perioperative complications in surgery for type A dissection. This perfusion strategy may help in reducing perioperative complications in this particular patient population.
Bakhtiary
Farhad
F
Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany. farhad@bakhtiary.de
Dogan
Selami
S
Zierer
Andreas
A
Dzemali
Omer
O
Oezaslan
Feyzan
F
Therapidis
Panagiotis
P
Detho
Faisal
F
Wittlinger
Thomas
T
Martens
Sven
S
Kleine
Peter
P
Moritz
Anton
A
Aybek
Tayfun
T
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass; D013504:Cardiovascular Surgical Procedures / Q000379:methods* / Q000401:mortality; D002560:Cerebrovascular Circulation / Q000502:physiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D013348:Subclavian Artery; D016019:Survival Analysis; D016896:Treatment Outcome