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DOI: 10.1055/s-2008-1038050
Safety of selective unilateral antegrade cerebral perfusion in surgica repair of thoracic aortic pathologies
Introduction: Antegrade cerebral perfusion (ACP) is the most supportive technique to prevent injury of the brain during hypothermic circulatory arrest. We reviewed our clinical results of all patients who underwent surgery of their thoracic aorta using HCA and unilateral antegrade cerebral perfusion (UACP).
Method: 120 pts (37 pts >70yrs, 6 pts >80yrs; mean age 62.6yrs) underwent reconstruction of their diseased aorta (39% emergent). Antegrade aortic perfusion during CPB was accomplished in all pts. Deep or moderate hypothermic circulatory arrest with UACP via the innominate artery was used for cerebral protection. Three pts (2.5%) presented with preoperative neurological complications. Mean UACP time was 46min (10–161min), mean core temperature during HCA was 24° C (18–28° C).
Results: Overall in-hospital mortality was 11.6%. It was higher in the acute pts group (19%) vs. the elective pts group (5.4%). Severe intra/postoperative low cardiac output syndrome was the main cause of mortality (55.5%) in the acute cohort. Regarding the pts age overall in-hospital mortality could be kept low in pts >70yrs: 4 pts acute vs. 2 pts elective group. New postoperative temporary neurological symptoms were found in 6 pts (5%) and in 2 pts (1.6%) new permanent neurological dysfunction occurred.
Conclusion: UACP during complex and prolonged repair of the thoracic aorta proves o be effective and reliable for cerebral protection. However, in emergent cases we still observed high hospital mortality mainly related to myocardial ischemia. This complication necessitates a better preoperative evaluation/diagnosis and perioperative management.