title: Ascending and transverse aortic arch repair: the impact of retrograde cerebral perfusion.
abstract: BACKGROUND
  The benefit of retrograde cerebral perfusion (RCP) with profound hypothermic circulatory arrest has been subject to much debate. We examined our experience with ascending and transverse arch repairs to determine the impact of retrograde cerebral perfusion on stroke and mortality.
  
  
  RESULTS
  Between August 1991 and June 2007, we performed 1107 repairs of the ascending and transverse aortic arch. RCP was used in 82% of cases (907 of 1107). Sixty-two percent were men (682 of 1107); median age was 64 years (range, 16 to 93 years). Perioperative variables were evaluated using univariate and multivariable analysis for mortality and stroke. Thiry-day mortality was 10.4% (115 of 1107). Stroke occurred in 2.8% (31 of 1107) of patients. Univariate risk factors for mortality were increasing age (P<0.0001), history of coronary artery disease (P=0.02), previous coronary artery bypass (P=0.02), emergency status (P<0.0001), acute dissection (P=0.02), rupture (P=0.0001), preoperative glomerular filtration rate, bypass time (P<0.0001), crossclamp time (P<0.007), RCP time (P<0.0001), and packed red blood cell transfusions (P=0.0001). Univariate risk factors for stroke included emergency status (P<0.02), cerebrovascular disease (P<0.02), and crossclamp time (P<0.04). Independent risk factors for mortality were glomerular filtration rate <90 mL/min (P=0.0004), emergency status (P=0.006), rupture (P=0.004), cardiopulmonary bypass time >120 minutes (P<0.04), and packed red blood cell transfusions (P=0.0002). Risk factors for stroke were emergency status (P<0.009) and hypertension (P<0.05). RCP was protective against mortality and stroke.
  
  
  CONCLUSIONS
  The use of RCP with profound hypothermic circulatory arrest was associated with a reduction in mortality and stroke. The use of RCP remains warranted during repairs of the ascending and transverse aortic arch.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, The University of Texas Houston Medical School, 6410 Fannin, Suite 425, Houston, TX 77030, USA. anthony.l.estrera@uth.tmc.edu
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Estrera
authors.forename: Charles C
authors.initials: CC
authors.lastname: Miller
authors.forename: Taek-Yeon
authors.initials: TY
authors.lastname: Lee
authors.forename: Pallav
authors.initials: P
authors.lastname: Shah
authors.forename: Hazim J
authors.initials: HJ
authors.lastname: Safi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality*