Experience with retrograde cerebral perfusion during proximal aortic surgery in 290 patients

We currently routinely use profound hypothermic circulatory arrest (PHCA) with retrograde cerebral perfusion (RCP) during repair of proximal aortic dissection and aneurysms involving the transverse aortic arch. Experimental data regarding the efficacy of RCP are conflicting. We retrospectively reviewed our experience with proximal aortic surgery to compare the results of PHCA performed with and without RCP.

From January 1987 through July 1996, 590 patients underwent ascending or transverse aortic arch operations. Of the 479 patients who required PHCA, RCP was utilized in 290 (60.5%). The patients who did not receive RCP had a higher prevalence of preexisting cerebrovascular disease, diabetes, and aortic dissection than those who did.

Overall 30-day and in-hospital mortality rates were 7.9% (38/479) and 8.8% (42/479), respectively; six (1.3%) intraoperative deaths were excluded from the analysis regarding neurologic complications. There were 19 strokes (4.0%). Comparing the patients who had RCP with those who did not, 30-day mortality rates were 3.4% (10/290) vs. 14.8% (28/189, p < 0.001), in-hospital mortality rates were 3.4% (10/290) vs. 16.9% (32/189, p < 0.001), and stroke rates were 2.4% (7/289) vs. 6.5% (12/184, p < 0.05), respectively.

Patients who had RCP during PHCA had lower mortality and stroke rates than those who did not. Although the higher prevalence of cerebrovascular disease, diabetes, and dissection in the latter group may have contributed to these differences, the clinical results confirm the safety and potential benefits of RCP, further supporting its use during proximal aortic surgery requiring circulatory arrest.