Retrograde cerebral perfusion with hypothermic circulatory arrest in aortic arch surgery: operative and long-term...

Clinical data were retrospectively collected for 207 consecutive patients who underwent aortic arch surgery using continuous retrograde cerebral perfusion (CRCP) and hypothermic circulatory arrest (HCA) at Tenri Hospital (138 patients) from 1988 to 1999, and at Nagoya University Hospital (69 patients) from 1990 to 2000. One hundred and 3 patients (50%) were operated upon for aortic dissection, and 104 patients (50%) for atherosclerotic aneurysm.

Hospital mortality was 12% (25 patients). HCA times were 44+/-20 minutes. Cardiopulmonary bypass time longer than 6 hours, low cardiac output syndrome, respiratory failure, and central nervous system (CNS) dysfunction contributed to hospital deaths. Late mortality was 16% (34 patients). The predictors of late deaths were age (>70 years), total arch replacement, HCA time >60 min., non-dissecting aneurysm, and postoperative CNS injury.

Operative results of aortic arch surgery using CRCP was generally satisfactory. However, the long-term results of total arch replacement for patients older than 70 years, non-dissecting aneurysm (particularly ruptured), and postoperative CNS injury were poor. Although prolonged duration of HCA may contribute to these poor results, other factors such as emergent surgery, late death due to aging, and systemic atherosclerosis are also considered to be risk factors.