Impact of retrograde cerebral perfusion on aortic arch aneurysm repair
| Autor: | Marek Ehrlich, Martin Grabenwöger, Georg Grubhofer, W.Christopher Fang, Guenther Laufer, Michael Havel, J Ankersmit, Ernst Wolner, Alfred Kocher |
|---|---|
| Rok vydání: | 1999 |
| Předmět: |
Aortic arch
Adult Male Pulmonary and Respiratory Medicine Extracorporeal Circulation Time Factors Aortic Rupture Aneurysm Sex Factors Hypothermia Induced medicine.artery medicine Prevalence Humans Cerebral perfusion pressure Aged Retrospective Studies Aortic dissection Aged 80 and over Neurologic Examination Chi-Square Distribution Aortic Aneurysm Thoracic Vascular disease business.industry Extracorporeal circulation Age Factors Middle Aged medicine.disease Perfusion Survival Rate Aortic Dissection Logistic Models Treatment Outcome Anesthesia Cerebrovascular Circulation Heart Arrest Induced Female Surgery Complication business Cardiology and Cardiovascular Medicine |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 118(6):1026-1032 |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/s0022-5223(99)70097-8 |
| Popis: | Objective: Protection of the brain is a primary concern in aortic arch surgery. Retrograde cerebral perfusion is a relatively new technique used for cerebral protection during profound hypothermic circulatory arrest. This study was designed to compare, retrospectively, the outcome of 109 patients undergoing aortic arch operation with and without the use of retrograde cerebral perfusion. Methods: Fifty-five patients had profound hypothermic circulatory arrest alone, and 54 patients had supplemental cerebral protection with retrograde cerebral perfusion. Mean age was 61 ± 13 years and 58 ± 14 years, respectively (mean ± standard deviation). Twenty-two preoperative and intraoperative characteristics, including age, sex, acuity, presence of aortic dissection, and aneurysm rupture, were similar in the 2 groups ( P > .05). Results: Mean circulatory arrest times (in minutes) were 30 ± 19 in the group without retrograde cerebral perfusion and 33 ± 19 in the group with retrograde cerebral perfusion, respectively. χ 2 Analysis revealed that patients operated on with the use of retrograde cerebral perfusion had significantly lower hospital mortality (15% vs 31%; P = .04) and in-hospital permanent neurologic complications (9% vs 27%; P = .01). Retrograde cerebral perfusion failed to reduce the prevalence of temporary neurologic dysfunction (17% vs 18%; P = .9). Stepwise multiple logistic regression revealed that extracorporeal circulation time, age, and lack of retrograde cerebral perfusion were statistically significant independent risk factors for hospital mortality. The same analysis revealed that lack of retrograde cerebral perfusion was the only significant independent risk factor for permanent neurologic dysfunction. Conclusion: Retrograde cerebral perfusion decreased the prevalence of permanent neurologic complications and the hospital mortality in patients undergoing aortic arch operations. (J Thorac Cardiovasc Surg 1999;118:1026-32) |
| Databáze: | OpenAIRE |
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