Objective : An evaluation of bilateral antegrade selective cerebral perfusion in complete aortic arch replacement.
Materials and Methods : From October 1995 through June 1999, bilateral antegrade selective cerebral perfusion was used in 160 interventions on the proximal thoracic aorta. In 68 of them, a complete aortic arch replacement was performed. Mean age of these patients was 64 ± 11 years.
Indication for operation was degenerative aneurysm in 41 (60%) patients, postdissection aneurysm in 20 (30%) patients, acute type A dissection in 6 (8%) and false aneurysm formation after previous aortic repair in 1 (2%) patient. Six (8%) operations were considered as emergency procedures, all for acute type A dissection. The arch vessels were reattached to a vascular prosthesis as a unit in 34 (50%) patients (island technique), a woven prefabricated aortic arch prosthesis with extension grafts for the arch vessels was used in another 34 (50%) patients.
Results : Fifty (73%) patients were awake and alert within 24 hours after operation, sixty-four (94%) within 48 hours. Mean duration of antegrade selective cerebral perfusion was 58 ± 20 minutes (time during which exclusively the brain was perfused), range 32-119 minutes.
Hospital mortality was 4.4% (n = 3). Cause of death was rupture of a distant aneurysm in 1 patient, rupture of a remote dissected aorta in one patient, and irreversible brain damage in one patient. Multivariate risk factor analysis failed to recognize variables associated with increased mortality. Temporary neurologic deficit occurred in 3 (4.4%) patients, permanent neurologic damage in another 2 (3%). Again, multivariate risk factor analysis failed to recognize risk factors for neurologic dysfunction.
Conclusion : Replacement of the aortic arch in combination with antegrade selective cerebral perfusion can be performed with a low mortality and a low incidence of neurologic damage.