Comparative clinical study between retrograde cerebral perfusion and selective cerebral perfusion in surgery for acute type A aortic dissection

Objective: Selection of a brain protection method is a primary concern for aortic arch surgery. We performed a retrospective study to compare the resp ective advantages and disadvantages of retrograde cerebral perfusion (RCP) and selective cerebral perfusion (SCP) in patients who underwent surgery fo r acute type A aortic dissection. Methods: The study reviewed 166 patients who underwent surgery at Nagoya University or its eight branch hospitals be tween January 1990 and August 1996. There were 91 patients who received SCP and 75 patients who underwent RCP. Results for these two groups were compa red. Results: There were no significant differences in age, gender, Marfan syndrome rate, DeBakey classification, or emergency operation rate. Rates o f various preoperative complications were similar except for aortic valve r egurgitation. Arch replacement was performed more often in SCP than in RCP patients (49% vs. 27%, P = 0.0028). There were no significant differences b etween groups in cardiac ischemic time or visceral organ ischemic time. How ever, RCP group showed shorter cardio-pulmonary bypass time (297 +/- 99 vs. 269 +/- 112 min, P = 0.013) and lower the lowest core temperature (21.6 +/ - 3.1 degrees C vs. 18.7 +/- 2.1 degrees C, P = 0.0001). SCP duration was l onger than RCP duration (103 +/- 56 vs. 54 +/- 24 min, P < 0.0001). Despite these differences, RCP patients were not significantly different from SCP patients with regard to any postoperative complication, neurological dysfun ction (16 vs. 19%), or operative mortality (all deaths within the hospitali zation; 24 vs. 21%). Regarding neurologic dysfunction, there were six cases of coma, six of motor paralysis, two of paraplegia and one of visual loss among SCP patients, and eight cases of coma, three of motor paralysis, and three of convulsion in the RCP group. The incidence of motor paralysis was higher in the SCP group, while the incidence of coma was higher in the RCP group. Conclusions: RCP can be performed without clamping or cannulation of the cervical arteries, which is an advantage in reducing the chances of ar terial injury or cerebral embolization. RCP is comparable to SCP in terms o f clinical outcome. (C) 1999 Elsevier Science B.V. All rights reserved.