Original article: cardiovascularProspective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion
Section snippets
Patients and methods
From June 1, 1997 to April 9, 1999, 84 patients had a total replacement of the transverse aortic arch in the National Cardiovascular Center, Osaka, Japan. Seventeen patients who underwent an emergent surgery because of acute aortic dissection or rupture of the aneurysm were excluded. Two patients who had a total aortic arch replacement via a left thoracotomy were also excluded from the analysis. Sixty consecutive patients who had a total arch replacement via a midsternotomy on an elective basis
Results
Total duration of the operation (RCP 365 ± 131, SCP 467 ± 218, p = 0.03 minutes; p = 0.03) and bypass time (175 ± 58, 215 ± 83 minutes; p = 0.03) were significantly longer in the SCP group. Duration of cardiac ischemia (99.8 ± 44.3, 106 ± 58 minutes; p = 0.6) and of circulatory arrest of the lower body (44.3 ± 13.9, 54.1 ± 26.3 minutes; p = 0.07) were similar. In the RCP group, the duration of the total circulatory arrest was 44.3 ± 13.9 minutes, and the duration of RCP was 33.1 ± 11.4 minutes.
Comment
Although brain complication remains a rare event after cardiac surgery, it is a major cause of postoperative mortality and morbidity in thoracic aortic surgery [2]. An alarming prevalence (1% to 83%) 3, 4 of postoperative neuropsychological dysfunction has been reported after cardiopulmonary bypass. Improvement of methods to assess the postoperative neuropsychiatric status has been achieved recently; however, there is no simple method to determine the incidence or severity of brain injury after
References (28)
- et al.
“Mini-mental state”A practical method for grading the cognitive state of patients for the clinician
J Psychiat Res
(1975) - et al.
Surgical treatment of aneurysm and/or dissection of the ascending aorta, and transverse aortic archfactors influencing survival in 717 patients
J Thorac Cardiovasc Surg
(1989) - et al.
Adverse effects on the brain in cardiac operation as assessed by biochemical psychometric, and radiologic methods
J Thorac Cardiovasc Surg
(1984) - et al.
Neuropsychologic outcome after deep hypothermic circulatory arrest in adults
J Thorac Cardiovasc Surg
(1999) - et al.
Atheroembolism from the ascending aorta
J Thorac Cardiovasc Surg
(1992) - et al.
Predictive factors for mortality and cerebral complications in arteriosclerotic aneurysm of the aortic arch
Ann Thorac Surg
(1999) - et al.
Proximal aortic perfusion for complex arch and descending aortic disease
J Thorac Cardiovasc Surg
(1998) - et al.
Management of the severely atherosclerotic ascending aorta during cardiac operations; a strategy for detection and treatment
J Thorac Cardiovasc Surg
(1992) - et al.
Deep hypothermia with circulatory arrest; determinants of stroke and early mortality in 656 patients
J Thorac Cardiovasc Surg
(1993) - et al.
Hypothermic circulatory arrest in operations on the thoracic aortadeterminants of operative mortality and neurologic outcome
J Thorac Cardiovasc Surg
(1994)
Impact of retrograde cerebral perfusion on ascending aortic and arch aneurysm repair
Ann Thorac Surg
Mortality and cerebral outcome in patients who underwent aortic arch operations using deep hypothermic circulatory arrest with retrograde cerebral perfusionno relation of early death, stroke, and delirium to the duration of circulatory arrest
J Thorac Cardiovasc Surg
Cold cerebroplegia. A new technique of cerebral protection during operations on the transverse aortic arch
J Thorac Cardiovasc Surg
Surgical treatment of aortic arch aneurysms in profound hypothermia and circulatory arrest
Ann Thorac Surg
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