Retrograde cerebral and distal aortic perfusion during ascending and thoracoabdominal aortic operations.
Publication/Presentation Date
8-1-1995
Abstract
BACKGROUND: Several alternative circulatory management techniques during thoracic aortic reconstruction have been implemented at this institution. This study was performed to assess whether retrograde cerebral perfusion during proximal aortic operations and distal aortic perfusion during thoracoabdominal aortic operations have improved outcomes.
METHODS: A retrospective review of 156 patients undergoing elective and emergent operations of the thoracic aorta over the past 7 years was performed. Seventy-five patients underwent proximal aortic procedures: 22 with ascending aneurysms, 45 with type A dissections, and 8 with arch reconstructions. Eighty-one patients underwent descending thoracic or thoracoabdominal procedures: 26 with Crawford type I aneurysms, 18 with type II, 8 with type III, 8 with type IV, 11 with traumatic transections, and 10 with type B dissections. Outcomes measured were neurologic injury, renal failure, and mortality.
RESULTS: For proximal aortic procedures, the stroke rate was 12% using cardiopulmonary bypass and 48% using hypothermic circulatory arrest. The addition of retrograde cerebral perfusion decreased the stroke rate to 0% (p < 0.01) and the mortality rate to 7.1% compared with 37% for hypothermic circulatory arrest (p < 0.05). For thoracic and thoracoabdominal aortic operations, straight cross-clamping resulted in a 27% rate of spinal cord injury and a 24% rate of renal failure, whereas the addition of distal aortic bypass resulted in a statistically significant reduction (p < 0.01) in neurologic injury to 7% and a notable, but not statistically significant, decrease in renal failure to 13%. Distal aortic bypass also reduced the mortality rate from 22% to 7% (p < 0.05).
CONCLUSIONS: Retrograde cerebral perfusion decreases the stroke rate and mortality rate in proximal aortic operations and distal aortic perfusion decreases the rates of neurologic injury, renal failure, and mortality in thoracoabdominal aortic operations.
Volume
60
Issue
2
First Page
345
Last Page
352
ISSN
0003-4975
Published In/Presented At
Bavaria, J. E., Woo, Y. J., Hall, R. A., Carpenter, J. P., & Gardner, T. J. (1995). Retrograde cerebral and distal aortic perfusion during ascending and thoracoabdominal aortic operations. The Annals of thoracic surgery, 60(2), 345–353. https://doi.org/10.1016/0003-4975(95)00447-s
Disciplines
Medicine and Health Sciences
PubMedID
7646094
Department(s)
Department of Surgery
Document Type
Article