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Clinical Results of Retrograde Cerebral Perfusion in Treatment of Aortic Disease

Tanzer Çalkavur, MD, Yüksel Atay, MD, Tahir Yadi, MD, Mustafa Çikirikçolu, MD, Levent Can, MD¹, Uur Gürcün, MD, Mustafa Özbaran, MD, Önol Bilkay, MD, Suat Büket, MD

Department of Cardiovascular Surgery 1 Department of Cardiology Ege University Medical Faculty zmir, Turkey

For reprint information contact: Suat Büket, MD Department of Cardiovascular Surgery Ege University Medical Faculty Bornova, zmir 35100, Turkey Tel:90 232 388 2866 Fax:90 232 339 0002 Email:bukets{at}bornova.ege.edu.tr

Between 1993 and 1998, 106 adults underwent ascending aorta or aortic arch operations using deep-hypothermic circulatory arrest and retrograde cerebral perfusion via the superior vena cava. Aortic lesions were acute type I dissection in 44 (41.5%), chronic type I dissection in 12 (11.3%), acute type II dissection in 6 (5.7%), chronic type II dissection in 9 (8.5%), ascending aorta or aortic arch aneurysms in 34 (32.1%), and an aneurysm of the sinus of Valsalva with aortic arch aneurysm in 1 (0.9%). The overall neurologic dysfunction rate was 6.6%. Early mortality was 18.8%. By multivariate analysis, circulatory arrest longer than 60 minutes and chronic renal failure were significant predictors of neurological dysfunction. Female gender, preoperative hemodynamic instability, circulatory arrest longer than 60 minutes, preoperative neurological dysfunction, and preoperative organ malperfusion were significant predictors of early mortality. We concluded that retrograde cerebral perfusion minimized neurological complications by preventing debris and air emboli and by providing adequate metabolic support in patients who needed circulatory arrest for surgical treatment of aortic pathology.