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Brain damage after aortic arch repair using selective cerebral perfusion

M Ohmi1, K Tabayashi, M Hata

  • 1Department of Thoracic and Cardiovascular Surgery, Tohoku University School of Medicine, Sendai, Japan.

The Annals of Thoracic Surgery
|November 4, 1998
PubMed
Summary

Selective cerebral perfusion for aortic arch repair carries risks. Preoperative assessment of occlusive arterial disease is crucial for predicting brain damage, while silent cerebral infarction appears not to be a significant risk factor.

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Area of Science:

  • Cardiovascular Surgery
  • Neurology
  • Vascular Disease

Background:

  • Selective cerebral perfusion (SCP) is a common technique for brain protection during aortic arch repair.
  • The precise causes of postoperative brain damage following this procedure remain incompletely understood.
  • This study investigates brain damage in relation to preoperative cerebral infarction and occlusive arterial disease.

Purpose of the Study:

  • To analyze the incidence and risk factors of postoperative brain damage after aortic arch repair using SCP.
  • To evaluate the role of preoperative cerebral infarction (both old and silent) and occlusive arterial disease in predicting brain injury.
  • To identify key factors for improved patient selection and risk stratification.

Main Methods:

  • A cohort of 60 patients undergoing aortic arch repair with SCP was retrospectively analyzed over 9 years.

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  • Preoperative cerebral infarction was assessed using CT/MRI in 50 patients.
  • Intracranial and extracranial occlusive arterial disease was evaluated via angiography in 35 patients.

    • Main Results:

    • Postoperative brain damage occurred in 10.5% of patients (6/57), with 3 cases of coma and 3 of hemiplegia.
    • Old cerebral infarction was present in 18% of patients, with 33% experiencing postoperative brain damage.
    • Occlusive arterial disease was identified in 20% of patients, showing a significantly higher incidence of brain damage (71%) compared to those without (4%).

    Conclusions:

    • Silent cerebral infarction (lacunar infarction, leukoaraiosis) does not appear to be a significant risk factor for postoperative brain damage.
    • Preoperative identification of intracranial and extracranial occlusive arterial disease is a critical predictor of brain damage risk.
    • Risk stratification based on vascular status is essential for patients undergoing aortic arch repair with SCP.