title: Antegrade cerebral protection in thoracic aortic surgery: lessons from the past decade.
abstract: OBJECTIVE
  Prolonged deep hypothermic circulatory arrest (DHCA) adversely affects outcome and quality of life in thoracic aortic surgery. Several techniques of antegrade cerebral perfusion are routinely used: bilateral selective antegrade cerebral protection (SACP) by introducing catheters in the innominate and left carotid artery, unilateral perfusion through the right axillary antegrade cerebral perfusion (RAACP) or a combination of right axillary perfusion with an additional catheter in the left carotid artery (RAACCP), resulting also in bilateral perfusion. The aim of the present study was to analyse the impact of the different approaches on the quality of life (QoL).
  
  
  METHODS
  The data of 292 patients who underwent surgery of the thoracic aorta using DHCA at our hospital between January 2004 and December 2007 have been analysed and a follow-up was performed focussing on QoL, assessed with the Short Form-36 Health Survey Questionnaire (SF-36). Results were analysed according to the type of cerebral perfusion and the duration of DHCA.
  
  
  RESULTS
  Patients' characteristics were similar in all groups. Of the total, 3.4% patients underwent DHCA (average 8.3+/-6.4 min) without ACP, 45.9% underwent SACP (average DHCA of 15.6+/-7.1 min), 40.4% had RAACP (average DHCA of 28.1+/-11.6 min) and 9.4% bilateral perfusion (RAACCP) (average DHCA of 43.1+/-16.7 min). The average follow-up was 23.2+/-15.1 months. QoL was preserved in all groups. For DHCA above 40 min, bilateral ACP provides superior midterm QoL than unilateral RAACP (average SF-36 95.1+/-44.4 vs 87.6+/-31.3; p=0.072).
  
  
  CONCLUSIONS
  When midterm QoL is assessed, bilateral SACP provides the best cerebral protection for prolonged DHCA (>40 min).
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Bern, Switzerland.
authors.forename: Eva S
authors.initials: ES
authors.lastname: Krähenbühl
authors.forename: Michel
authors.initials: M
authors.lastname: Clément
authors.forename: David
authors.initials: D
authors.lastname: Reineke
authors.forename: Martin
authors.initials: M
authors.lastname: Czerny
authors.forename: Mario
authors.initials: M
authors.lastname: Stalder
authors.forename: Thierry
authors.initials: T
authors.lastname: Aymard
authors.forename: Jürg
authors.initials: J
authors.lastname: Schmidli
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic / Q000601:surgery*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome