Cerebral Protection in Aortic Arch Surgery: Clinical Outcomes from Single Institute
Pramote Porapakkham MD1, Pornwalee Porapakkham MD2
Affiliation : 1 Department of Cardiothoracic Surgery, Central Chest Institute of Thailand, Nonthaburi, Thailand 2 Cardiology and Intervention Department, Central Chest Institute of Thailand, Nonthaburi, Thailand
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 signi(cid:976)icantly 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
