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

Background. Various methods of cerebral protection have been used during aortic arch operations. Deep hypothermia with circulatory arrest is the most common technique but has a limited safe period for circulatory arrest. Selective cerebral perfusion has been introduced to prolong this safe period. We reviewed our experience with antegrade selective cerebral perfusion during surgical repair of the thoracic aorta. Methods. Between November 1996 and December 1998, 57 consecutive patients were operated on for aortic arch aneurysms using selective cerebral perfusion. Forty-one were men (71.9%), and 16 were women. The mean age was 63.2 years. Thirty-seven patients had chronic aneurysms, and 20 had type A acute dissection. Preoperative, intraoperative, and postoperative factors were analyzed by univariate and multivariate analysis to identify predictors of early mortality and transient neurologic dysfunction. Results. There were no permanent neurologic deficits. The early mortality rate was 8.8% (5 patients). Multivariate analysis revealed preoperative renal failure (p = 0.0338) and repeat thoracotomy for bleeding (p = 0.0201) to be independent risk factors for early mortality. The factor postoperative cardiac complications (p = 0.0368) was the only independent predictor of transient neurologic dysfunction, and it occurred in 3 patients (5.3%). Conclusions. The present study confirmed that preoperative renal failure and repeat thoracotomy for bleeding are significant predictors of mortality in aortic arch operations using selective cerebral perfusion and that cerebral perfusion time has no influence on the postoperative outcome. We believe that selective cerebral perfusion is an optimal technique of cerebral protection during operations on the aortic arch.