CEREBRAL COMPLICATIONS AND DISTAL FALSE LUMEN IN THE REPAIR OF AORTICDISSECTION WITH RETROGRADE CEREBRAL PERFUSION

Background. In aortic dissection, patent distal false lumen at long-te rm follow-up leads to complications. We investigated the feasibility o f an open distal anastomosis under retrograde cerebral perfusion. Meth ods. During a 15-year period (1981-1995), 51 patients with type A diss ection underwent 59 surgical repairs. In 1990, a distal open anastomos is with retrograde cerebral perfusion (group II) was introduced to rep lace the aortic cross clamp method (group I). Mean retrograde cerebral perfusion time was 50 minutes (range 22 to 65 minutes) with no neurol ogic sequelae in surviving patients.Results. Operative mortality was 2 8.6% in group I, and 16.1% in group II, At long-term follow-up, dilata tion of the false lumen (more than 50 mm in diameter) occurred in 56.2 % (9/16) in group I, and 4 patients died of aortic rupture. There was no mortality in group IZ, and dilatation of the distal false lumen occ urred ia only 15.3% (p<0.05). Conclusions. Use of retrograde cerebral perfusion in aortic dissection allowed for adequate time to per form a safe, open, distal anastomosis, Intraoperative cerebral complications and enlarged patent false lumens decreased significantly.