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DOI: 10.1055/s-0030-1269128
Clinical benefits of cerebral perfusion during surgery for acute type A dissection
Objective: Acute type A aortic dissection is a life-threatening condition with a certain incidence of cerebral complications after surgery. We investigated the influence of cerebral perfusion during aortic surgery on postoperative results.
Methods: From 05/2000 until 06/2008, 126 consecutive patients suffering from acute type A dissections were admitted for surgery in our institution; their data were analyzed retrospectively. 113 of these patients were operated on using different methods of cerebral protection: Deep hypothermic circulatory arrest (Group DH, n=39, 34.5%), antegrade cerebral perfusion (Group AC, n=45, 39.8%), and retrograde cerebral perfusion (Group RC, n=29, 25.7%). The groups did not differ in age, Euroscore, gender or hemodynamic parameters.
Results: The lowest 30 day mortality (15.5%) and long term (15.5%) death rate was obtained in the AC group, while the RC group (early deaths 24.1%, late deaths 27.6%) and the DH group (early deaths 33.5%, late deaths 23.1%) achieved less convincing results. New-onset strokes occurred more often in the DH group (17.9%) than in the AC (6.7%) and the RC (6.9%) group. Early postoperative delirium was more frequent in the RC group (10.3%) than in the AC (6.7%) or the DH (2.6%) group. The patients of the AC group required more treatment-time (median 7 days) on ICU and in hospital (median 15 days) than patients of the RC (median 5 days; 11 days) and the DH (median 3 days; 10 days) group.
Conclusion: Antegrade cerebral perfusion during acute aortic dissection surgery confers a clinical benefit compared to retrograde perfusion or deep hypothermic arrest.