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Ann Thorac Surg 2007;83:S796-S798
© 2007 The Society of Thoracic Surgeons

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Supplement

Aortic Arch Replacement Using Selective Cerebral Perfusion

First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan

Accepted for publication October 17, 2006.

^_* Address correspondence to Dr Kazui, First Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu431-3192, Japan. (Email: tkazui{at}hama-med.ac.jp).

Presented at Aortic Surgery Symposium X, New York, NY, April 27–28, 2006.

BACKGROUND: The present study was conducted to report our clinical experience with aortic arch replacement using selective cerebral perfusion (SCP) and determine the independent predictors of in-hospital mortality and neurologic outcome.

METHODS: We studied 472 consecutive patients who underwent aortic arch replacement using SCP between January 1986 and February 2006. All operations were performed with the aid of hypothermic extracorporeal circulation, SCP, and in most cases, systemic circulatory arrest for open distal anastomosis. The etiology of aortic diseases included acute aortic dissection in 126 patients (27%), chronic aortic dissection in 102 (21%), and degenerative aneurysm in 245 (52%). Total arch replacement was performed in 420 patients (89%). Mean SCP time was 88 ± 32 minutes.

RESULTS: The overall in-hospital mortality was 9.3%, but it dropped significantly to 4.1% in the most recent 266 patients. Independent predictors of in-hospital mortality were early series, renal/mesenteric ischemia, pump time, increasing age, chronic renal dysfunction, history of cerebrovascular accident (CVA), and previous ascending or arch operation. Overall postoperative temporary and permanent neurologic dysfunction were 4.7% and 3.2%, respectively. A history of CVA was the only predictor of temporary neurologic dysfunction, whereas CVA and pump time were independent predictors of permanent neurologic dysfunction. SCP time had no significant correlation with in-hospital mortality and neurologic outcome.

CONCLUSIONS: SCP facilitates complicated aortic arch replacement, resulting in a reduction of mortality and morbidity for arch aneurysms or dissections.

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