Impact of retrograde cerebral perfusion on aortic arch aneurysm repair

Objective: Protection of the brain is a primary concern in aortic arch surg ery. Retrograde cerebral perfusion is a relatively new technique used for c erebral protection during profound hypothermic circulatory arrest. This stu dy was designed to compare, retrospectively, the outcome of 109 patients un dergoing aortic arch operation with and without the use of retrograde cereb ral perfusion. Methods : Fifty-five patients had profound hypothermic circu latory arrest alone, and 54 patients had supplemental cerebral protection w ith retrograde cerebral perfusion. Mean age was 61 +/- 13 years and 58 +/- 14 years, respectively (mean +/- standard deviation). Twenty-two preoperati ve and intraoperative characteristics, including age, sex, acuity, presence of aortic dissection, and aneurysm rupture, were similar in the 2 groups ( P >.05). Results: Mean circulatory arrest times (in minutes) were 30 +/- 19 in the group without retrograde cerebral perfusion and 33 +/- 19 in the gr oup with retrograde cerebral perfusion, respectively. chi(2) Analysis revea led that patients operated on with the use of retrograde cerebral perfusion had significantly lower hospital mortality (15% vs 31%; P =.04) and in-hos pital permanent neurologic complications (9% vs 27%; P = .01), Retrograde c erebral perfusion failed to reduce the prevalence of temporary neurologic d ysfunction (17% vs 18%; P = .9). Stepwise multiple logistic regression reve aled that extracorporeal circulation time, age, and lack of retrograde cere bral perfusion were statistically significant independent risk factors for hospital mortality The same analysis revealed that lack of retrograde cereb ral perfusion was the only significant independent risk factor for permanen t neurologic dysfunction, Conclusion: Retrograde cerebral perfusion decreas ed the prevalence of permanent neurologic complications and the hospital mo rtality in patients undergoing aortic arch operations.