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Ann Thorac Surg 2007;83:S805-S810
© 2007 The Society of Thoracic Surgeons

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Supplement

Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience

^a Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka
^b Department of Thoracic Surgery, Fujita Health University, Aichi, Japan

^_* Address correspondence to Dr Sasaki, Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan. (Email: hmsasaki{at}hsp.ncvc.go.jp).

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

BACKGROUND: The purpose of this study was to evaluate the recent outcome of integrated total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion.

METHODS: Between 2000 and 2005, 305 patients underwent elective total arch replacement for arch or distal arch aneurysm using a Dacron (DuPont, Wilmington, DE) quadrifurcated prosthesis through a median sternotomy. There were 34 dissecting and 271 nondissecting aneurysms. Brain protection was standardized using antegrade selective cerebral perfusion with right axillary artery cannulation at 20° to 28°C. Risk factors for early mortality and neurologic complications were investigated using multivariate logistic regression analyses.

RESULTS: The durations of hypothermic circulatory arrest, myocardial ischemia, selective cerebral perfusion, cardiopulmonary bypass, and surgery were 60.9 ± 16.8, 125.2 ± 39.3, 150.1 ± 39.0, 229.8 ± 91.4, and 466.4 ± 175.8 minutes, respectively. Seven patients died, for a 2.3% early mortality. Permanent neurologic dysfunction developed in 5 patients (1.6%), and temporary neurologic dysfunction in 20 (6.6%). The mid-term survival rate was 94.6% ± 1.5% at 3 years. On multivariate analyses, prolonged surgery was a risk factor for early mortality. Preoperative cerebral hypoperfusion was a significant determinant for temporary neurologic dysfunction and male gender for permanent neurologic dysfunction.

CONCLUSIONS: Integrated total arch replacement using antegrade selective cerebral perfusion with right axillary artery cannulation yields a favorable outcome with low mortality and cerebral morbidity rates.

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