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J Thorac Cardiovasc Surg 2003;125:849-854
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology

Deep hypothermic circulatory arrest and antegrade selective cerebral perfusion during ascending aorta-hemiarch replacement: A retrospective comparative study

Marco Di Eusanio, MDa, Ronald M. J. Wesselink, MD, PhDb, Wim J. Morshuis, MD, PhDa, Karl M. Dossche, MD, PhDa, Marc A. A. M. Schepens, MD, PhDa

From the Departments of Cardiopulmonary Surgerya and Anaesthesiology and Intensive Care,b St Antonius Hospital, Nieuwegein, The Netherlands.

Received for publication April 25, 2002. Revisions requested June 14, 2002; revisions received July 26, 2002. Accepted for publication Aug 6, 2002. Address for reprints: Marco Di Eusanio, MD, Department of Cardiopulmonary Surgery, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands (E-mail: m_dieus{at}hotmail.com).

Objective: We sought to compare the results of ascending aorta-hemiarch replacement by using 2 different methods of cerebral protection in terms of hospital mortality, neurologic outcome, and systemic morbidity and to determine predictive risk factors associated with hospital mortality and neurologic outcome after ascending aorta-hemiarch replacement.
Methods: Between January 1995 and September 2001, 289 patients (mean age, 62.2 ± 13.2 years; urgent status, 122/289 [42.2%]) underwent ascending aorta-hemiarch replacement with the aid of antegrade selective cerebral perfusion (161 patients) or deep hypothermic circulatory arrest (128 patients).
Results: Overall hospital mortality was 11.4% (deep hypothermic circulatory arrest group, 13.3%; antegrade selective cerebral perfusion group, 9.9%; P = .375). A logistic regression analysis revealed acute type A dissection (P = .001; odds ratio, 4.3) and age of greater than 70 years (P = .019; odds ratio, 2.5) to be independent predictors of hospital mortality. The permanent neurologic dysfunction rate was 9.3% (deep hypothermic circulatory arrest group, 12.5%; antegrade selective cerebral perfusion group, 7.6%; P = .075). Logistic regression analysis revealed acute type A dissection (P = .001; odds ratio, 6.7) and history of cerebral infarction-transient ischemic attack (P = .038; odds ratio, 3.4) to be independent predictors of permanent neurologic dysfunction. The transient neurologic dysfunction rate was 8.0% (deep hypothermic circulatory arrest group, 7.1%; antegrade selective cerebral perfusion group, 8.7%; P = .530). Acute type A dissection (P = .001; odds ratio, 5.1) was indicated as an independent predictor of transient neurologic dysfunction by means of logistic regression. Renal dysfunction (postoperative creatinine level of >250 µmol/L; deep hypothermic circulatory arrest, 10 [7.8%]; antegrade selective cerebral perfusion, 6 [3.7%]; P = .030), as well as prolonged intubation time (deep hypothermic circulatory arrest, 3.8 ± 6.3 days; antegrade selective cerebral perfusion, 2.2 ± 2.5 days; P = .005) were more common in the deep hypothermic circulatory arrest group.
Conclusion: The use of antegrade selective cerebral perfusion and deep hypothermic circulatory arrest during ascending aorta-hemiarch replacement resulted in acceptable hospital mortality and neurologic outcome. Reduced postoperative intubation time and better renal function preservation were observed in the antegrade selective cerebral perfusion group.




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