OPEN DISTAL ANASTOMOSIS IN RETROGRADE CEREBRAL PERFUSION FOR REPAIR OF ASCENDING AORTIC DISSECTION

Background. In patients with aortic dissection, a patent distal false lumen at long-term follow-up leads to complications. We investigated t he feasibility of performing an open distal anastomosis using retrogra de cerebral perfusion. Methods. Over a 10-year period, 41 patients wit h acute type A aortic dissection underwent 43 surgical repairs. In 199 1, an open distal anastomosis using retrograde cerebral perfusion (gro up 2) was introduced to replace the standard aortic cross-clamp method (group 1). The mean retrograde cerebral perfusion time was 47.3 minut es (range, 22 to 67 minutes), and there were no neurologic sequelae in surviving patients. Results. The operative mortality rate was 18.5% i n group 1 and 18.7% in group 2. At long-term follow-up, dilatation of the false lumen (more than 50 mm in diameter) occurred in 9 of 18 pati ents (50%) in group 1, and 2 patients died of aortic rupture. There we re no deaths in group 2, and dilatation of the distal false lumen occu rred in only 15.4% of patients (p < 0.05). Conclusions. The use of ret rograde cerebral perfusion in patients with acute aortic dissection pr ovides adequate time to perform a safe, open, distal anastomosis, and could decrease significantly the rate of enlarged, patent, false lumin a. (C) 1997 by The Society of Thoracic Surgeons.