CIRCULATORY MANAGEMENT WITH RETROGRADE CEREBRAL PERFUSION FOR ACUTE TYPE-A AORTIC DISSECTION

Background Cerebral circulation during urgent repair of acute type A a ortic dissection has traditionally been managed with cardiopulmonary b ypass and aortic cross clamping proximal to the innominate artery or b y the use of hypothermic circulatory arrest (HCA). The more recently i ntroduced retrograde cerebral perfusion (RCP) may confer additional ce rebral protection during elective aortic arch reconstruction. The purp ose of this study was to demonstrate the efficacy of RCP in the urgent repair of acute type A aortic dissection. Methods and Results We eval uated 60 consecutive patients who underwent repair of acute type A aor tic dissection over a 6-year period. Patients were grouped according t o intraoperative circulatory management strategies. Group 1 consisted of 41 patients operated on early in the series who were managed by car diopulmonary bypass and standard aortic cross clamping (n=21) with con version to HCA (n=20) if the intimal tear extended into the aortic arc h. Since 1993, 19 patients, who make up group 2, were managed with rou tine open distal anastomosis and HCA with RCP. Data were analyzed for clinically evident, radiographically confirmed cerebrovascular acciden ts and 60-day mortality and evaluated by chi(2) analysis. Stroke and m ortality rates of patients managed with either cardiopulmonary bypass or HCA were 26.3% and 29.3%, respectively. Patients undergoing RCP exp erienced statistically significant reductions in rates of confirmed ce rebrovascular accidents (0%, P=.015) and mortality (5.3%, P=.04). Conc lusions We conclude that the introduction of circulatory management us ing RCP with HCA during urgent operative repair of acute type A aortic dissection has significantly improved both stroke and mortality rates .