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Ann Thorac Surg 2000;70:3-8
© 2000 The Society of Thoracic Surgeons
a First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
b Second Department of Surgery, Sapporo Medical University, Sapporo, Japan
Address reprint request to Dr Kazui, First Department of Surgery, Hamamatsu University School of Medicine, 3600 Handa-cho, Hamamatsu, 431–3192, Japan
e-mail: surg1ss{at}hama-med.ac.jp
Presented at the Thirty-sixth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 31–Feb 2, 2000.
Background. We report our clinical experience with total arch replacement using aortic arch branched graft in an attempt to determine the independent predictors of both in-hospital mortality and neurologic outcome.
Methods. We studied 220 consecutive patients who underwent total arch replacement using aortic arch branched graft between May 1990 and June 1999. All operations were performed with the aid of hypothermic extracorporeal circulation, antegrade selective cerebral perfusion, and open distal anastomosis.
Results. The overall in-hospital mortality rate was 12.7%. Multivariable analysis showed independent determinants of in-hospital mortality to be chronic renal failure, long pump time, participation in early series, and shock. Postoperative permanent neurologic dysfunction was 3.3%. On multivariable analysis, old cerebral infarct and pump time were independent determinants of permanent neurologic dysfunction. The selective cerebral perfusion time had no significant influence on in-hospital mortality or neurologic outcome. The 5-year survival rate including in-hospital deaths was 79% ± 6%.
Conclusions. Selective cerebral perfusion allows increased ease of performance of total arch replacement, a complex and time-consuming procedure, and helps reduce periprocedural mortality and morbidity in patients with aortic arch aneurysm and those with acute aortic dissection.
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Ann. Thorac. Surg. 2000 70: 8-9.
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