RETROGRADE CEREBRAL AND DISTAL AORTIC PERFUSION DURING ASCENDING AND THORACOABDOMINAL AORTIC OPERATIONS

Background. Several alternative circulatory management techniques duri ng thoracic aortic reconstruction have been implemented at this instit ution. This study was performed to assess whether retrograde cerebral perfusion during proximal aortic operations and distal aortic perfusio n during thoracoabdominal aortic operations have improved outcomes. Me thods. A retrospective review of 156 patients undergoing elective and emergent operations of the thoracic aorta over the past 7 years was pe rformed. Seventy-five patients underwent proximal aortic procedures: 2 2 with ascending aneurysms, 45 with type A dissections, and 8 with arc h reconstructions. Eighty-one patients underwent descending thoracic o r thoracoabdominal procedures: 26 with Crawford type I aneurysms, 18 w ith type II, 8 with type III, 8 with type IV, 11 with traumatic transe ctions, and 10 with type B dissections. Outcomes measured were neurolo gic injury, renal failure, and mortality. Results. For proximal aortic procedures, the stroke rate was 12% using cardiopulmonary bypass and 48% using hypothermic circulatory arrest. The addition of retrograde c erebral perfusion decreased the stroke rate to 0% (p < 0.01) and the m ortality rate to 7.1% compared with 37% for hypothermic circulatory ar rest (p < 0.05). For thoracic and thoracoabdominal aortic operations, straight cross-clamping resulted in a 27% rate of spinal cord injury a nd a 24% rate of renal failure, whereas the addition of distal aortic bypass resulted in a statistically significant reduction (p < 0.01) in neurologic injury to 7% and a notable, but not statistically signific ant, decrease in renal failure to 13%. Distal aortic bypass also reduc ed the mortality rate from 22% to 7% (p < 0.05). Conclusions. Retrogra de cerebral perfusion decreases the stroke rate and mortality rate in proximal aortic operations and distal aortic perfusion decreases the r ates of neurologic injury, renal failure, and mortality in thoracoabdo minal aortic operations.