title: Arch replacement using antegrade selective cerebral perfusion for shaggy aorta.
abstract: BACKGROUND
  Embolic stroke during arch replacement is a serious concern in patients with shaggy aorta.
  
  
  OBJECTIVE
  To evaluate shaggy aorta in patients who received total aortic arch replacement with antegrade selective cerebral perfusion utilizing axillary perfusion.
  
  
  METHODS
  Between January 2005 and December 2010, 63 patients underwent preoperative contrast-enhanced computed tomography scanning of the aorta to evaluate atheromatous plaque. We analyzed operative data to investigate which factors were associated with outcomes and survival.
  
  
  RESULTS
  Shaggy aorta was found in 34 (54%) patients. There were 3 (5%) cases in the ascending aorta, 26 (41%) in the aortic arch, and 19 (30%) in the descending aorta. Operative mortality occurred in 1 (2%) patient. Although stroke occurred in 2 (3%) shaggy aorta patients, shaggy aorta was not associated with an increased likelihood of stroke (p = 0.4951). Survival was significantly lower in patients with shaggy descending aorta (p = 0.0411) and in patients >75-years old (p = 0.0200); these traits were identified as independent risk factors for late death (p = 0.0368 and p = 0.0100, respectively).
  
  
  CONCLUSIONS
  We concluded that our perfusion technique protects patients with shaggy aorta against embolism, and that the survival is lower in patients with shaggy descending aorta.
authors: Department of Cardiovascular Surgery, Fujita Health University, Toyoake, Japan. ytakagi@fujita-hu.ac.jp
authors: Yasushi
authors: Y
authors: Takagi
authors: Motomi
authors: M
authors: Ando
authors: Kiyotoshi
authors: K
authors: Akita
authors: Michiko
authors: M
authors: Ishida
authors: Kan
authors: K
authors: Kaneko
authors: Masato
authors: M
authors: Sato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography / Q000379:methods; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D002560:Cerebrovascular Circulation; D004617:Embolism / Q000209:etiology / Q000517:prevention & control; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D058226:Plaque, Atherosclerotic; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome