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Cerebral Protection in Aortic Arch Surgery: Clinical Outcomes from Single Institute

Porapakkham P , Porapakkham P

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Porapakkham P, Porapakkham P. Cerebral Protection in Aortic Arch Surgery: Clinical Outcomes from Single Institute. J Med Assoc Thai 2018;101:621-7.

Background: The current practices to prevent cerebral function from ischemic damage during aortic arch surgery include deep hypothermic circulatory arrest [DHCA], retrograde cerebral perfusion [RCP], and selective antegrade cerebral perfusion [SACP]. The optimal strategy for protecting the brain remains controversial. A ten-year clinical experience and follow-up of patients with aortic surgery involving arch was reported.

Objective: To evaluate clinical outcomes between different cerebral protection methods during aortic arch surgery.

Materials and Methods: Medical records of aortic aneurysm patients underwent circulatory arrest during the operations between January 2005 and December 2015 were reviewed.

Results: One hundred-thirteen patients underwent circulatory arrest during aortic surgery involving arch were studied. DHCA was employed in all patients. Of these, 79 patients received ACP as an adjunct (ACP group) and 34 patients used only DHCA or combined with RCP (non-ACP group). Duration of circulatory arrest time, bypass time, and cardiac ischemic time were significantly longer in ACP group (44.04±1.7 versus 29.4±1.9 minutes, p<0.001; 215.39±8.4 versus 174.7±12.6 minutes, p = 0.009, and 140.72±7.9 versus 76.78±9.7 minutes, p<0.001, respectively). There was no difference in clinical outcomes between the two groups, including 30-day mortality (14% versus 17.6%, p = 0.61), major stroke (6.3% versus 8.8%, p = 0.63) and minor stroke (10.1% versus 2.9%, p = 0.19).

Conclusion: The superiority of ACP over the other approach of cerebral protection was not proved in the present study. However, it is more likely to use ACP in case of complex arch operation with extended period of circulatory arrest time.

Keywords: Cerebral protection, Deep hypothermic circulatory arrest, Retrograde cerebral perfusion, Antegrade cerebral perfusion

 

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