C. Yamashita et al., OPEN DISTAL ANASTOMOSIS IN RETROGRADE CEREBRAL PERFUSION FOR REPAIR OF ASCENDING AORTIC DISSECTION, The Annals of thoracic surgery, 64(3), 1997, pp. 665-669
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.