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Original Articles: Cardiovascular

Antegrade Cerebral Perfusion for Acute Type A Aortic Dissection in 120 Consecutive Patients

Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Goethe University Hospital, Frankfurt/Main, Germany

Accepted for publication October 3, 2007.

^_* Address correspondence to Dr Bakhtiary, Department of Thoracic and Cardiovascular Surgery, Johann Wolfgang Geothe University Hospital, Theodor-Stern-Kai 7, Frankfurt/Main, 60596, Germany (Email: farhad{at}bakhtiary.de).

Background: Treatment of acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurologic morbidity and mortality. The following study investigates clinical results after modification of perfusion technique for cardiopulmonary bypass as well as temperature management.

Methods: Between January 2000 and August 2006, 120 consecutive patients underwent repair of acute type A dissection. Selective antegrade cerebral perfusion through the right subclavian artery combined with mild systemic hypothermia (30°C) was used in all patients.

Results: Mean cardiopulmonary bypass time was 144 ± 53 minutes, and mean myocardial ischemic time was 98 ± 49 minutes. Isolated cerebral perfusion was performed for 25 ± 12 minutes. Mean core temperature amounted to 30.1° ± 2.2°C. Chest tube drainage during the first 24 hours was 525 ± 220 mL. Mean ventilation time was 54 ± 22 hours. Elevation of serum lactate levels at 1, 12, and 24 hours postoperatively rose to 22 ± 14, 18 ± 11, and 19 ± 8 mg/dL respectively. We observed new postoperative permanent neurologic deficits in 5 patients (4.2%) and TND in 3 patients (2.5%). The 30-day mortality rate was 5% (n = 6). After a mean follow-up period of 2.8 years, 104 patients (87%) were still alive.

Conclusions: Antegrade cerebral perfusion in combination with mild hypothermia offered sufficient neurologic protection in our patient cohort, provided adequate distal organ protection, and reduced perioperative complications in surgery for type A dissection. This perfusion strategy may help in reducing perioperative complications in this particular patient population.

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