Antegrade selective cerebral perfusion during operations on the thoracic aorta: Our experience

Background. Various methods of cerebral protection have been used during ao rtic arch operations. Deep hypothermia with circulatory arrest is the most common technique but has a limited safe period for circulatory arrest. Sele ctive cerebral perfusion has been introduced to prolong this safe period. W e reviewed our experience with antegrade selective cerebral perfusion durin g surgical repair of the thoracic aorta. Methods. Between November 1996 and December 1998, 57 consecutive patients w ere operated on for aortic arch aneurysms using selective cerebral perfusio n. Forty-one were men (71.9%), and 16 were women. The mean age was 63.2 yea rs. Thirty-seven patients had chronic aneurysms, and 20 had type A acute di ssection. Preoperative, intraoperative, and postoperative factors were anal yzed by univariate and multivariate analysis to identify predictors of earl y mortality and transient neurologic dysfunction. Results. There were no permanent neurologic deficits. The early mortality r ate was 8.8% (5 patients). Multivariate analysis revealed preoperative rena l failure (p = 0.0338) and repeat thoracotomy for bleeding (p = 0.0201) to be independent risk factors for early mortality. The factor postoperative c ardiac complications (p = 0.0368) was the only independent predictor of tra nsient neurologic dysfunction, and it occurred in 3 patients (5.3%). Conclusions. The present study confirmed that preoperative renal failure an d repeat thoracotomy for bleeding are significant predictors of mortality i n aortic arch operations using selective cerebral perfusion and that cerebr al perfusion time has no influence on the postoperative outcome. We believe that selective cerebral perfusion is an optimal technique of cerebral prot ection during operations on the aortic arch. (Ann Thorac Surg 2000;70:10-6) (C) 2000 by The Society of Thoracic Surgeons.