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Experience with cerebral perfusion in total aortic arch replacement.
Anil Z Apaydin1, Fatih Islamoglu, Hikmet Iyem
1Department of Cardiovascular Surgery, Ege University Medical School, Izmir, Turkey. apaydina@efes.net.tr
Summary
Total aortic arch replacement is feasible with acceptable outcomes. Excessive blood transfusion is linked to hospital death, while longer hypothermic circulatory arrest and hypertension increase temporary neurological dysfunction risk.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Vascular Surgery
Background:
- Cerebral circulation interruption poses significant risks during aortic arch repair.
- Total aortic arch replacement is a complex procedure with potential for mortality and neurological complications.
Purpose of the Study:
- To identify perioperative risk factors for mortality and neurological morbidity.
- To evaluate outcomes following total aortic arch replacement.
Main Methods:
- Retrospective review of 23 patients undergoing total aortic arch replacement between 1995 and 2002.
- Utilized hypothermic circulatory arrest (HCA) with selective cerebral perfusion (SCP).
- Analyzed risk factors for mortality and morbidity using univariate analysis.
Main Results:
- In-hospital mortality rate was 17.4%.
- No major strokes occurred in survivors; 5 patients experienced temporary neurological dysfunction (TND).
- Excessive blood transfusion correlated with hospital death; prolonged HCA and hypertension were linked to TND.
Conclusions:
- Total aortic arch replacement can be performed with acceptable mortality and neurological morbidity.
- Midterm survival is excellent for hospital survivors.
- HCA duration did not impact in-hospital mortality when SCP was employed.