Unilateral antegrade selective cerebral perfusion in aortic surgery: clinical outcomes at different levels of hypothermia.
Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either <24 or > or =24. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia (<24); and group B comprised 40 patients undergoing moderate hypothermia (> or =24). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Korea.
Jae Hoon
JH
Lee
Cheol Hyun
CH
Chung
Joon Kyu
JK
Kang
Suk Jung
SJ
Choo
Hyun
H
Song
Jae Won
JW
Lee
D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery; D001018:Aortic Diseases / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D001831:Body Temperature; D002315:Cardiopulmonary Bypass / Q000379:methods; D002560:Cerebrovascular Circulation; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015424:Reperfusion / Q000379:methods; D012307:Risk Factors; D012769:Shock / Q000150:complications; D020521:Stroke / Q000150:complications; D016896:Treatment Outcome