Key result
Retrograde cerebral perfusion during deep-hypothermic circulatory arrest shows a ~7% neurologic dysfunction rate.
Why the study?
The clinical outcomes and neurological complications associated with retrograde cerebral perfusion during deep-hypothermic circulatory arrest for aortic surgery were not well characterized.
What are the rates and predictors of neurologic dysfunction and early mortality in adults undergoing ascending aorta or aortic arch operations using deep-hypothermic circulatory arrest and retrograde cerebral perfusion?
Observational (n=106)
What are the rates and predictors of neurologic dysfunction and early mortality in adults undergoing ascending aorta or aortic arch operations using deep-hypothermic circulatory arrest and retrograde cerebral perfusion?
Retrograde cerebral perfusion during deep-hypothermic circulatory arrest for aortic surgery is associated with a 6.6% rate of neurologic dysfunction, which is strongly predicted by circulatory arrest times exceeding 60 minutes.
These rates in an observational cohort should not change practice; leaves open need for randomized comparisons of perfusion strategies in aortic arch surgery.
Between 1993 and 1998, 106 adults underwent ascending aorta or aortic arch operations using deep-hypothermic circulatory arrest and retrograde cerebral perfusion via the superior vena cava. Aortic lesions were acute type I dissection in 44 (41.5%), chronic type I dissection in 12 (11.3%), acute type II dissection in 6 (5.7%), chronic type II dissection in 9 (8.5%), ascending aorta or aortic arch aneurysms in 34 (32.1%), and an aneurysm of the sinus of Valsalva with aortic arch aneurysm in 1 (0.9%). The overall neurologic dysfunction rate was 6.6%. Early mortality was 18.8%. By multivariate analysis, circulatory arrest longer than 60 minutes and chronic renal failure were significant predictors of neurological dysfunction. Female gender, preoperative hemodynamic instability, circulatory arrest longer than 60 minutes, preoperative neurological dysfunction, and preoperative organ malperfusion were significant predictors of early mortality. We concluded that retrograde cerebral perfusion minimized neurological complications by preventing debris and air emboli and by providing adequate metabolic support in patients who needed circulatory arrest for surgical treatment of aortic pathology.
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Çalkavur et al. (1998) conducted an observational in Aortic disease (n=106). Retrograde cerebral perfusion via the superior vena cava during deep-hypothermic circulatory arrest was evaluated on Neurologic dysfunction. Retrograde cerebral perfusion during deep-hypothermic circulatory arrest for aortic operations resulted in an overall neurologic dysfunction rate of 6.6% and early mortality of 18.8%.
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