Retrograde and antegrade cerebral perfusion: results in short elective arch reconstructive times.
BACKGROUND
Debate remains regarding optimal cerebral circulatory management during relatively noncomplex, short arch reconstructive times. Both retrograde cerebral perfusion with deep hypothermic circulatory arrest (RCP/DHCA) and antegrade cerebral perfusion with moderate hypothermic circulatory arrest (ACP/MHCA) have emerged as established techniques. The aim of the study was to evaluate perioperative outcomes between antegrade and retrograde cerebral perfusion techniques for elective arch reconstruction times less than 45 minutes.


METHODS
Between 1997 and September 2008, 776 cases from two institutions were reviewed to compare RCP/DHCA and ACP/MHCA perfusion techniques. At the University of Pennsylvania, 682 were treated utilizing RCP/DHCA cerebral protection. At the University of Bologna, 94 were treated with ACP/MHCA and bilateral cerebral perfusion.


RESULTS
Mean cerebral ischemic time and visceral ischemic time differed between RCP/DHCA and ACP/MHCA (p < 0.001). Multivariate analysis showed age more than 65 years, atherosclerotic aneurysm, and cross-clamp time as predictors of the composite endpoint of mortality, neurologic event, and acute myocardial infarction. There was no significant difference in permanent neurologic deficit, temporary neurologic dysfunction, or renal failure, between RCP/DHCA and ACP/MHCA. Mortality was comparable across both techniques.


CONCLUSIONS
Both RCP/DHCA and ACP/MHCA have emerged as effective techniques for selected aortic arch operations with low morbidity and mortality. Univariate analysis revealed no statistically significant differences in primary or secondary outcomes between techniques for aortic reconstruction times less than 45 minutes. Data from this study demonstrate that selective use of either RCP/DHCA or ACP/MHCA provides excellent cerebral and visceral outcomes for elective open aortic surgery with short arch reconstructive times.
Milewski
Rita Karianna
RK
Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. milewskr@uphs.upenn.edu
Pacini
Davide
D
Moser
G William
GW
Moeller
Patrick
P
Cowie
Doreen
D
Szeto
Wilson Y
WY
Woo
Y Joseph
YJ
Desai
Nimesh
N
Di Marco
Luca
L
Pochettino
Alberto
A
Di Bartolomeo
Roberto
R
Bavaria
Joseph E
JE
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D002545:Brain Ischemia / Q000517:prevention & control*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology*; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010477:Perfusion / Q000379:methods*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods