title: Arterial access through the right subclavian artery in surgery of the aortic arch improves neurologic outcome and mid-term quality of life.
abstract: BACKGROUND
  We have shown that selective antegrade cerebral perfusion improves mid-term quality of life in patients undergoing surgical repair for acute type A aortic dissection and aortic aneurysms. The aim of the study was to assess the impact of continuous cerebral perfusion through the right subclavian artery on immediate outcome and quality of life.
  
  
  METHODS
  Perioperative data of 567 consecutive patients who underwent surgery of the aortic arch using deep hypothermic circulatory arrest have been analyzed. Patients were divided into three groups, according to the management of cerebral protection. Three hundred eighty-seven patients (68.3%) had deep hypothermic circulatory arrest with pharmacologic protection with pentothal only, 91 (16.0%) had selective antegrade cerebral perfusion and pentothal, and 89 (15.7%) had continuous cerebral perfusion through the right subclavian artery and pentothal. All in-hospital data were assessed, and quality of life was analyzed prospectively 2.4 +/- 1.2 years after surgery with the Short Form-36 Health Survey Questionnaire.
  
  
  RESULTS
  Major perioperative cerebrovascular injuries were observed in 1.1% of the patients with continuous cerebral perfusion through the right subclavian artery, compared with 9.8% with selective antegrade cerebral perfusion (p < 0.001) and 6.5% in the group with no antegrade cerebral perfusion (p = 0.007). Average quality of life after an arrest time between 30 and 50 minutes with continuous cerebral perfusion through the right subclavian artery was significantly better than selective antegrade cerebral perfusion (90.2 +/- 12.1 versus 74.4 +/- 40.7; p = 0.015).
  
  
  CONCLUSIONS
  Continuous cerebral perfusion through the right subclavian artery improves considerably perioperative brain protection during deep hypothermic circulatory arrest. Irreversible perioperative neurologic complications can be significantly reduced and duration of deep hypothermic circulatory arrest can be extended up to 50 minutes without impairment in quality of life.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Berne, Switzerland. franzimmer@yahoo.de
authors.forename: Franz F
authors.initials: FF
authors.lastname: Immer
authors.forename: Barbara
authors.initials: B
authors.lastname: Moser
authors.forename: Eva S
authors.initials: ES
authors.lastname: Krähenbühl
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.forename: Mario
authors.initials: M
authors.lastname: Stalder
authors.forename: Friedrich S
authors.initials: FS
authors.lastname: Eckstein
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000784:Aortic Dissection / Q000601:surgery*; D017130:Angioplasty; D001013:Aorta, Thoracic / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D001132:Arm / Q000294:innervation; D020516:Brachial Plexus Neuropathies / Q000175:diagnosis / Q000209:etiology*; D001921:Brain / Q000098:blood supply*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D010477:Perfusion; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D011788:Quality of Life; D013348:Subclavian Artery