AORTIC-ARCH OPERATION USING SELECTIVE CEREBRAL PERFUSION FOR NONDISSECTING THORACIC ANEURYSM

Background. Risks of increasing mortality and disability in aortic arc h operations using the selective cerebral perfusion method for nondiss ecting aneurysm have not yet been determined. A multicenter, retrospec tive study was employed.Methods. The subjects were 143 patients who we re admitted to one of the nine cardiovascular centers between January 1988 and December 1993, including 15 with ruptured aneurysm. A graft r eplacement of the transverse aortic arch or distal arch was performed in 80 patients, extensive aortic reconstruction comprising simultaneou s replacement of the ascending or descending thoracic aorta (or both) in 46, and patch repair of involved arch in 17. The mean postoperative follow-up period was 19 months. Results. Hospital mortality was 36/14 3 patients (25.2%). Univariate analysis revealed that age of 70 years or more, ruptured aneurysm, and renal dysfunction affected hospital mo rtality. Neurologic deficits were noted in 15 patients (10.5%). Reoper ation was performed in 13 patients for residual distal aneurysm or fal se aneurysm. Late death occurred in 10 patients and were due to vascul ar complications in 6. Multivariate analysis confirmed that aneurysmal rupture and renal dysfunction were independent predictors for vascula r death including hospital mortality. Conclusions. The present study c onfirmed that age, aneurysmal rupture, and renal dysfunction were sign ificant predictors for mortality and disability in the aortic arch ope ration using selective cerebral perfusion for nondissecting thoracic a neurysm. (C) 1997 by The Society of Thoracic Surgeons