title: Immediate clinical outcome after prolonged periods of brain protection: retrospective comparison of hypothermic circulatory arrest, retrograde, and antegrade perfusion.
abstract: OBJECTIVE
  We aimed to compare the immediate clinical outcome after different cerebral perfusion methods, and examine the factors affecting the mortality and neurological outcome.
  
  
  METHODS
  Between 1993 and 2006, 339 patients underwent proximal aortic operations using a period of cerebral protection. Among these, 161 patients (mean age of 55 +/- 12 years) who required cerebral protection longer than 25 minutes were included in the analysis. Ascending aorta with or without root was replaced in all patients. In addition, total arch replacement was performed in 36 patients. All patients were cooled to rectal temperature of 16 degrees C. Hypothermic circulatory arrest without adjunctive perfusion was used in 48 patients. Retrograde or antegrade cerebral perfusion was added in 94 and 19 patients, respectively. The mean duration of total cerebral protection was 42 +/- 17 minutes.
  
  
  RESULTS
  Overall mortality was 15.5% (25/161) and did not differ among the perfusion groups. There was no difference in the incidence of overall neurological events, temporary neurological dysfunction, or major stroke among the groups. Multivariate analysis revealed that transfusion of >3 units of blood (p < 0.03) was an incremental risk factor for mortality. History of hypertension (p < 0.03), coexisting systemic diseases (p < 0.005), and transfusion of >3 units of blood (p < 0.04) were predictors of temporary neurological dysfunction.
  
  
  CONCLUSIONS
  In proximal aortic operations requiring prolonged periods of cerebral protection, the mortality and neurological morbidity are not determined by the type of cerebral protection method only. Factors like hypertension and diabetes may play a role in the development of temporary neurological dysfunction.
authors: Department of Cardiovascular Surgery, Ege University Medical School, Bornova, Izmir, Turkey. anil.apaydin@ege.edu.tr
authors: Anil Z
authors: AZ
authors: Apaydin
authors: Fatih
authors: F
authors: Islamoglu
authors: Fatma Z
authors: FZ
authors: Askar
authors: Cagatay
authors: C
authors: Engin
authors: Hakan
authors: H
authors: Posacioglu
authors: Tahir
authors: T
authors: Yagdi
authors: Fatih
authors: F
authors: Ayik
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001013:Aorta, Thoracic / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010477:Perfusion; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult