[Surgical outcomes of transverse aortic arch replacement]

The surgical outcomes of transverse aortic arch replacement were analyzed for the cases of 33 consecutive patients who underwent operations during the seven years between July 1989 and March 1996. Sixteen patients were atherosclerotic aneurysm (group T), 17 patients were acute or chronic aortic dissection involving aortic arch (group D). As for brain protection during aortic arch reconstruction, selective cerebral perfusion was employed in 16 patients of group T and 11 patients of group D. In 6 patients of group D with acute type A aortic dissection or chronic type B dissection, deep hypothermic circulatory arrest at 18 approximately 20 degrees C of rectal temperature was employed. In 14 patients of group T, selective cerebral perfusion was simultaneously started when we begun cardiopulmonary bypass. There were one operative death in group T patients (operative mortality 6.2%) and two in group D patients (operative mortality 11.8%). Perioperative stroke was occurred in two patients of group T with complete recovery in one and with partial recovery in the other. The latter patient died of medistinitis and graft infection. There was no hospital death nor stroke in group D patients. Duration of selective cerebral perfusion was 157.8 +/- 54.4 minutes in group T patients, 140.1 +/- 66.5 minutes in group D patients (n = 11), duration of circulatory arrest was 49.5 +/- 11.4 minutes in 6 patients of group D patients, respectively. In 27 patients who underwent operation with selective cerebral perfusion, morbidity of stroke was 7.4% (two patients). These were caused by technical failure during arch vessel reconstruction and seemed to be avoidable. In conclusion, it is reasonable to employ selective cerebral perfusion for aortic arch reconstruction in atherosclerotic aneurysm of transverse aortic arch. In aortic dissection, either selective cerebral perfusion or deep hypothermic circulatory arrest is justified as cerebral protection during operation.