C. Yamashita et al., CEREBRAL COMPLICATIONS AND DISTAL FALSE LUMEN IN THE REPAIR OF AORTICDISSECTION WITH RETROGRADE CEREBRAL PERFUSION, Journal of Cardiovascular Surgery, 38(6), 1997, pp. 581-587
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.