Surgical management of type A aortic dissection: evaluation of predisposing factors for postoperative neurologic complication and late reoperation

The technique of cerebral protection during hypothermic circulatory arrest remains controversial. Forty-seven patients underwent operations for type A aortic dissection in the past 9 years. During hypothermic circulatory arrest, selective cerebral perfusion and retrograde cerebral perfusion was applied in 12 and seven patients, respectively. The mortality rate was 28.6% in patients without adjunctive cerebral perfusion, 25.0% in selective cerebral perfusion patients, and zero in the retrograde cerebral perfusion group (P > 0.05). However, there was no mortality by cerebral injury in cerebral perfusion groups (P = 0.03). Age (P = 0.001), hypothermic circulatory arrest time (P = 0.012), and acuity (P = 0.013) were predisposing factors for cerebral injury, but cerebral perfusion has not yet been found to be a protective factor (P = 0.56). Nine late reoperations and three deaths occurred during the follow-up period. Marfan syndrome was the only predisposing factor for late reoperation (P = 0.016). In summary, although further studies are still required, retrograde cerebral perfusion is a possible cerebral protective factor. In addition, periodic follow-up is mandatory, especially in patients with Marfan syndrome.