BRAIN-DAMAGE AFTER AORTIC-ARCH REPAIR USING SELECTIVE CEREBRAL PERFUSION

Background. Selective cerebral perfusion is one of the most popular me thods for cerebral protection during aortic arch repair. However, caus es of postoperative brain damage are not fully understood. We analyzed brain damage after aortic arch repair using selective cerebral perfus ion for true aortic arch aneurysm in regard to preoperative cerebral i nfarction and intracranial and extracranial occlusive arterial disease . Methods, Over a 9-year period, 60 patients with hue aortic arch aneu rysm underwent aortic arch repair using selective cerebral perfusion. Postoperative brain damage was evaluated in regard to preoperative cer ebral infarction detected by computed tomography, magnetic resonance i maging, or both in 50 patients and intracranial and extracranial occlu sive arterial disease detected by digital subtraction angiography, mag netic resonance angiography, or both in 35 patients. Results. Seven (1 2%) of the 60 patients died within 30 days of operation. Postoperative brain damage occurred in 6 (10.5%) (3, coma, and 3, hemiplegia) of 57 patients; 3 patients who died without awakening were excluded. Preope ratively, old cerebral infarction was detected in 9 patients (18%), an d silent cerebral infarction (lacunar infarction and leukoaraiosis) wa s diagnosed in 26 patients (52%). Postoperative brain damage occurred in 3 (33%) of the 9 patients with preoperative cerebral infarction and in 3 (23%) of 13 patients with negative preoperative brain findings; this excludes 2 patients who died without awakening. No patient with s ilent cerebral infarction had postoperative brain damage. Occlusive ar terial disease was detected in 7 patients (20%). The incidence of brai n damage in these patients was 71% (5/7), which was significantly grea ter than that of 4% (1/28) in patients without occlusive arterial dise ase (p < 0.001). Conclusions. Silent cerebral infarction may not be a risk factor for postoperative brain damage. Preoperative evaluation of intracranial and extracranial occlusive arterial disease provides imp ortant information as to whether a patient might sustain brain damage after aortic arch repair using selective cerebral perfusion. (Ann Thor ac Surg 1998;66:1250-3) (C) 1998 by The Society of Thoracic Surgeons.