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Published on: February 17, 2013
Brain protection using antegrade selective cerebral perfusion: a multicenter study
Marco Di Eusanio1, Marc A A M Schepens, Wim J Morshuis
1Department of Cardiopulmonary Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands. m_dieus@hotmail.com
Insights
Antegrade selective cerebral perfusion shows encouraging results for brain protection during thoracic aortic surgery. This method did not impact hospital mortality or neurologic outcomes, regardless of replacement extent or perfusion duration.
Area of Science:
- Cardiovascular Surgery
- Neurosurgery
- Thoracic Aortic Surgery
Background:
- Antegrade selective cerebral perfusion (ASCP) is utilized for brain protection during thoracic aortic surgery.
- Evaluating ASCP's efficacy and identifying predictors of mortality and neurologic complications is crucial.
Purpose of the Study:
- To assess the outcomes of ASCP in thoracic aortic surgery.
- To identify predictors of hospital mortality and adverse neurologic outcomes.
Main Methods:
- A cohort of 588 patients undergoing aortic surgery with ASCP between 1995 and 2002.
- Analysis included patient demographics, surgical techniques (e.g., separated graft, elephant trunk), and perfusion times.
- Logistic regression was used to identify predictors of mortality and neurologic dysfunction.
Main Results:
- Overall hospital mortality was 8.7%.
- Predictors of mortality included urgent operation, recent neurologic event, tamponade, unplanned coronary revascularization, and pump time.
- Permanent and transient neurologic dysfunction rates were 3.8% and 5.6%, respectively, with tamponade being a key predictor.
Conclusions:
- ASCP demonstrated encouraging results in reducing hospital mortality and brain complications.
- The extent of aortic replacement and duration of cerebral perfusion did not significantly influence mortality or neurologic outcomes.
Background:
To evaluate the results of antegrade selective cerebral perfusion as a method of brain protection during surgery of the thoracic aorta and to determine predictors of hospital mortality and adverse neurologic outcome.
Methods:
Between October 1995 and March 2002, 588 patients underwent aortic surgery with the aid of antegrade selective cerebral perfusion. There were 334 men (56.8%); the mean age was 63.7 +/- 11.8 years. One hundred sixty-two patients (27.6%) underwent urgent operation. The separated graft technique was employed to reimplant the arch vessels in 230 patients (65.3%) of the 352 requiring aortic arch replacement. Associated procedures were performed in 254 patients (43.2%). One hundred twelve patients underwent elephant trunk procedure. The mean cerebral perfusion time was 67 +/- 37 minutes.
Results:
The overall hospital mortality rate was 8.7%. A logistic regression analysis revealed urgent operation, recent central neurologic event, tamponade, unplanned coronary artery revascularization and pump time to be independent predictors of hospital mortality (p < 0.05). The permanent neurologic dysfunction rate was 3.8%. A logistic regression analysis showed tamponade to be independent predictor of permanent neurologic dysfunction (p < 0.05). The transient neurologic dysfunction rate was 5.6%. Recent central neurologic event, tamponade, coronary disease, and aortic valve replacement were indicated as independent predictors of transient neurologic dysfunction by logistic regression (p < 0.05).
Conclusions:
In our experience the utilization of antegrade selective cerebral perfusion resulted in encouraging results in terms of hospital mortality and brain complications. Neither the extent of the replacement nor the duration of the cerebral perfusion had an impact on hospital mortality and neurologic outcome.
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