Antegrade versus retrograde cerebral perfusion in relation to postoperative complications following aortic arch surgery for acute aortic dissection type A

J Card Surg. 2008 Sep-Oct;23(5):480-7. doi: 10.1111/j.1540-8191.2008.00587.x. Epub 2008 May 7.

Abstract

Background: Aortic arch surgery is impossible without the temporary interruption of brain perfusion and therefore is associated with high incidence of neurologic injury. The deep hypothermic circulatory arrest (HCA), in combination with antegrade or retrograde cerebral perfusion (RCP), is a well-established method of brain protection in aortic arch surgery. In this retrospective study, we compare the two methods of brain perfusion.

Materials and methods: From 1998 to 2006, 48 consecutive patients were urgently operated for acute type A aortic dissection and underwent arch replacement under deep hypothermic circulatory arrest (DHCA). All distal anastomoses were performed with open aorta, and the arch was replaced totally in 15 cases and partially in the remaining 33 cases. Our patient cohort is divided into those protected with antegrade cerebral perfusion (ACP) (group A, n = 23) and those protected with RCP (group B, n = 25).

Results: No significant difference was found between groups A and B with respect to cardiopulmonary bypass-time, brain-ischemia time, cerebral-perfusion time, permanent neurologic dysfunction, and mortality. The incidence of temporary neurologic dysfunction was 16.0% for group A and 43.50% for group B (p = 0.04). The mean extubation time was 3.39 +/- 1.40 days for group A and 4.96 +/- 1.83 days for group B (p = 0.0018). The mean ICU-stay was 4.4 +/- 2.3 days for group A and 6.9 +/- 2.84 days for group B (p = 0.0017). The hospital-stay was 14.38 +/- 4.06 days for group A and 19.65 +/- 6.91 days for group B (p = 0.0026).

Conclusion: The antegrade perfusion seems to be related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization, and hence lower total cost.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Dissecting / pathology
  • Aneurysm, Dissecting / surgery*
  • Aortic Aneurysm, Thoracic / pathology
  • Aortic Aneurysm, Thoracic / surgery*
  • Aortic Arch Syndromes / surgery*
  • Brain / blood supply*
  • Cerebrovascular Circulation
  • Circulatory Arrest, Deep Hypothermia Induced / methods*
  • Cohort Studies
  • Female
  • Health Status Indicators
  • Humans
  • Incidence
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Perfusion / methods*
  • Postoperative Complications / etiology
  • Postoperative Complications / prevention & control*
  • Retrospective Studies
  • Risk Factors
  • Time Factors