Predictive factors for mortality and cerebral complications in arteriosclerotic aneurysm of the aortic arch

Background. The incidence of cerebral complications is high in patients wit h aortic arch aneurysm. Methods. Between December 1977 and December 1995, 246 patients with arterio sclerotic arch aneurysm underwent operation. Thirty-nine patients had an an eurysm involving the entire arch, 193 had only distal arch aneurysm, and 14 had arch aneurysm extending to the descending aorta. Eighty-seven patients underwent replacement of the total arch, 85 had replacement of only the di stal arch, 14 had simultaneous replacement of the descending aorta, 45 had patch repair, and 15 had thromboexclusion. Selective cerebral perfusion was used in 112 patients and partial bypass in 58 in the earlier series of pat ients, but deep hypothermic circulatory arrest with retrograde cerebral per fusion technique was exclusively applied in the most recent 76 patients. Results. There were 50 (20%) early deaths and 37 (19%) late deaths. Postope rative stroke was found in 26 (11%) patients of which 13 (50%) died. Mutual predictive factors for postoperative mortality and stroke were earlier ser ies, preoperative chronic renal failure, ruptured aneurysm, arch clamping d uring procedure, and using partial cardiopulmonary bypass. Among 129 patien ts operated on during the most recent 5 years, early mortality and incidenc e of stroke decreased to 14.7% and 6.9%, respectively. Conclusions. Results of operations for arteriosclerotic aneurysms of the tr ansverse aortic arch in 246 patients during a period of 17 years have been improving but are still not satisfactory. (C) 1999 by The Society of Thorac ic Surgeons.