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Rivista di Chirurgia Cardiaca, Vascolare e Toracica
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ORIGINAL ARTICLES CARDIAC SECTION
The Journal of Cardiovascular Surgery 2006 Dicembre;47(6):691-8
Nine years experience of aortic arch repair with the aid of antegrade selective cerebral perfusion
Pacini D. 1, Di Marco L. 1, Marsilli D. 2, Mikus E. 1, Loforte A. 1, Sobaih F. 2, Di Bartolomeo R. 1
1 Department of Cardiac Surgery S.Orsola-Malpighi Hospital University of Bologna, Bologna, Italy
2 Department of Cardiac Anesthesiology S.Orsola-Malpighi Hospital University of Bologna, Bologna, Italy
Aim. Antegrade selective cerebral perfusion (ASCP) is gaining widespread popularity in aortic arch surgery because it has been demonstrated to be an optimal technique of cerebral protection. This study demonstrates the clinical results of aortic arch repair with ASCP.
Methods. Between November 1996 and September 2004, 250 patients underwent thoracic aorta replacement using ASCP under moderate hypothermia. Mean patients age was 63±11.5 years. Presenting pathologies were chronic aneurysm in 136 patient (54.4%), type A acute aortic dissection in 80 patients (32%), post-dissection aneurysm in 30 patients (12%). Ascending aorta and hemiarch replacement was performed in 63 patients (25.2%), ascending aorta and total arch replacement in 131 patients (52.4%), total arch replacement in 33 patients (13.2%), total arch and descending aorta replacement in 10 patients (4%) and complete replacement of the thoracic aorta in 13 patients (5.2%).
Results. Hospital mortality was 11.6%. Multivariate analysis showed preoperative renal failure (P=0.050), cerebral perfusion time (P<0.001), pulmonary complications (P=0.009) and postoperative dialysis (P=0.030) as risk factors for hospital mortality. Permanent neurologic deficits occurred in 4 patients (1.6%) and coronary artery disease (P=0.029) was found to be the only independent risk factor. Transient neurologic deficits were noted in 18 patients (7.2%). Multivariate analysis revealed age (P=0.043), coronary artery disease (P=0.036), urgent/emergency status of the operation (P=0.016) and concomitant aortic valve replacement (P=0.001) to be independent predictors of transient neurologic dysfunction. The actuarial survival rate at 7 years was 61.7%.
Conclusion. Our results confirmed that ASCP is a safe method of brain protection allowing complex aortic repairs to be performed with good results in terms of hospital mortality and neurologic outcome. Cerebral perfusion time did not influence postoperative outcome. The use of moderate hypothermia avoided all undesirable effects of deep hypothermia.