Neurologic outcome after surgery of the aortic arch: Comparison of deep hypothermic arrest,antegrade and retrograde cerebral perfusion

Introduction Neurologic deficits are still a major complication of aortic arch surgery. We therefore compared cerebral protection by deep hypothermic circulatory arrest (DHCA), antegrade (ACP) and retrograde (RCP) cerebral perfusion. Patients and Method 64 consecutive patients who underwent replacement of the aortic arch for aneurysms or dissections from January 1999 through August 2001 were analysed retrospectively for clinical and neurologic outcome. For DHCA core temperature was lowered to 18°C and was kept between 18 and 24°C in the perfused groups. Selective antegrade cerebral perfusion (ACP) was achieved either via the subclavian artery or the brachiocephalic trunc. Retrograde cerebral perfusion (RCP) was performed via the superior vena cava. Results Indication for surgery was type A acute dissection or ruptured aneurysm in 39 patients, chronic dissection and aneurysm without rupture in 25 patients. Operative procedure was partial arch replacement in 46 patients and total arch replacement in 18 patients. For cerebral protection retrograde cerebral perfusion (RCP) was used in 22 Patients (23±11 min.), ACP in 30 patients (25±19 min.) and DHCA in 14 patients (23±13 min.). Mortality was 17% (11 of 64 patients: ACP 7, RCP 2 and DHCA 2). Neurologic deficits occured in 5%, without differences for groups. Conclusion For this patient cohort, needing comparatively short times for aortic arch reconstruction, a low neurologic complication rate without significant differences for the method of cerebral perfusion was observed.