Arch and descending aortic aneurysms: influence of perfusion technique on neurological outcome

Objective: Although cannulation of the femoral artery is used routinely for thoracic aortic operations with hypothermic circulatory arrest, retrograde perfusion through the descending aorta carries the risk of cerebral malper fusion or embolism. We have, therefore, routinely used a central cannulatio n technique for distal arch and descending aortic operations since 1995. In this study, we compared neurological outcome in consecutive patients under going femoral versus ascending aortic perfusion for these aneurysms. Method s: Between 1987 and 1998, 61 patients underwent aortic resection with circu latory arrest, but without retrograde cerebral perfusion, for lesions of th e aortic arch and descending aorta. Thirty-one patients had fusiform true a neurysms, 19 had aortic dissection and 11 had extensive saccular or false a neurysms. Thirty-two patients (52%) were perfused via the femoral artery (g roup A), and 29 patients (48%) from the ascending aorta (group B). Operativ e mortality and morbidity, and neurological outcome, were reviewed. Results ; There were no differences between the groups in mean age, pathology, abdo minal and peripheral vascular disease, net perfusion time, or circulatory a rrest time. There: were four hospital deaths (three in group A and one in g roup B; P = 0.61), including one neurological death in group A, group A suf fered a higher incidence of neurological events (nine patients: 28%) than g roup B (two patients: 7%; P = 0.03). Temporary focal neurological deficits occurred in both groups (two patients in group A, 6% and two patients in gr oup B, 7%; P > 0.99), but permanent injury occurred exclusively in group A (seven patients: four with monoplegia, one with hemiplegia, and two with di ffuse cerebral injury with one death: P = 0.01). Conclusions: Anterograde p erfusion using a proximal aortic cannula. provides a low risk of cerebral e mbolism and allows extensive aortic resection with low morbidity. (C) 1999 Published by Elsevier Science B.V. All rights reserved.