IMPACT OF RETROGRADE CEREBRAL PERFUSION ON ASCENDING AORTIC AND ARCH ANEURYSM REPAIR

Purpose. The effect of retrograde cerebral perfusion on the incidence of stroke and death among patients undergoing repair of aneurysms of t he ascending aorta and transverse arch was determined. Material and Me thods. Between January 1991 and March 1995, 161 patients were operated on for aneurysms of the ascending aorta and transverse arch. Thirty-t hree of the patients (20%) had an aneurysm of the ascending aorta only and 128 (80%) had aneurysms of both the ascending aorta and the trans verse arch. All the patients underwent cardiopulmonary bypass, profoun d hypothermia, and circulatory arrest, and 120 (74%) also underwent re trograde cerebral perfusion. Median pump time was 143 minutes (range, 21 to 461 minutes). Median circulatory arrest time was 42 minutes (ran ge, 8 to 111 minutes), and median myocardial ischemic time was 71 minu tes (range, 14 to 306 minutes). Results. The overall 30-day mortality rate was 6% (9 patients) and the incidence of stroke was 4% (7 patient s). The use of retrograde cerebral perfusion demonstrated a protective effect against stroke (3 of 120 patients, or 3%) compared with no ret rograde cerebral perfusion (4 of 41 patients, or 9%; odds ratio, 0.24; confidence interval, 0.06 to 0.99; p < 0.049). This was most signific ant in patients more than 70 years of age; none of the 36 elderly pati ents who received retrograde cerebral perfusion had a stroke, compared with 3 of the 13 (23%) who did not (p < 0.003). Only pump time was as sociated with an increased risk of stroke (odds ratio, 1.01; 95% confi dence interval, 1.00 to 1.02; p < 0.005). Pump time also was associate d with increased mortality (odds ratio, 1.01; 95% confidence interval, 1.00 to 1.02; p < 0.008). Conclusion. Retrograde cerebral perfusion d ecreased the incidence of stroke in patients undergoing repair of aneu rysms of the ascending aorta and transverse arch. (C) 1977 by The Soci ety of Thoracic Surgeons.