[Early and long-term results of surgery for aortic arch aneurysms using selective cerebral perfusion]

We report our operative technique for atherosclerotic arch aneurysms and early and long term results of the surgery.

Between April 1992 and December 2001, 80 consecutive patients underwent operation for atherosclerotic arch aneurysms. Their mean age was 70 +/- 7 years. Sixty-six (82.5%) patients were operated on electively. All operations were performed under median sternotomy using hypothermic circulatory arrest and selective antegrade cerebral perfusion. Total arch replacement was performed in 66 cases, proximal hemiarch replacement in 4 cases, distal arch replacement using stent graft implantation via aortic arch incision in 8 cases, and patch angioplasty in 2 cases. In 9 of these patients in whom mobile arch atheroma was revealed by intraoperative epiaortic ultrasonography, isolation technique was employed to avoid embolic stroke.

Overall in-hospital mortality was 10.0% (8 of 80 patients). Postoperative temporary neurologic dysfunction was 7.5%, and stroke rate was 5.0%. The 3-year, and 5-year actuarial survival rate including hospital death was 79.3% and 75.3% respectively. The 3-year, and 5-year cardiovascular event free survival rate was 68.3% and 60.0% respectively.

The early and long-term results of surgery for atherosclerotic arch aneurysms were acceptable. Selective cerebral perfusion is an effective brain protective adjunct.