Bilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta
Objective: To assess risk factors for hospital death and neurologic outcome after surgery on the proximal thoracic aorta using moderate hypothermic circulatory arrest and bilateral antegrade selective cerebral perfusion. Methods: From October 1995 through June 1999, 163 patients with a mean age of 63 ^ 11 years underwent surgery using bilateral antegrade selective cerebral perfusion. Degenerative aneurysms (55%) and acute type A dissection (28%) were the predominant indications for operation. Forty-six (28%) operations were considered as emergency procedure. Twenty-four (15%) procedures were reoperations. Results: Mean ASCP time was 48 ^ 20 min. Hospital mortality was 8.6% (n  14; 70% con®dence limit (CL): 6.4±10.8%). Univariate risk factors for hospital mortality were acute type A dissection (P  0:003), central neurologic damage ,24 h before the operation (P  0:000), preoperative hemodynamic instability (P  0:034), and rethoracotomy for any cause (P  0:036). Logistic regression analysis identi®ed central neurologic damage ,24 h (P  0:006, odds ratio 14) as an independent risk factor. Temporary neurologic damage occurred in 3.8% (n  6; 70% CL: 2.3±5.3%) of patients. Logistic regression analysis indicated preoperative hemodynamic instability (P  0:003, odds ratio 13) as an independent risk factor. Perioperative permanent central neurologic damage was reported in another 3.8% (n  6; 70% CL: 2.3±5.3%) patients. Acute type A dissection (P  0:018, odds ratio 8) and the non-use of a midline sternotomy (P  0:049, odds ratio 8) were retained as independent risk factors. Conclusion: Hospital mortality and perioperative neurologic complications are not signi®cantly in ̄uenced by the duration of antegrade selective cerebral perfusion. Overall complication rate is low. q 2000 Elsevier Science B.V. All rights reserved.