Background
Cerebral perfusion during aortic arch surgery has various surgical strategies. We retrospectively analyzed outcome of deep hypothermic circulatory arrest (DHCA) without additional cerebral perfusion to DHCA and antegrade or retrograde cerebral perfusion strategies.
Methods:
Since 2004, 177 patients underwent elective aortic arch repair with circulatory arrest. Aortic dissections cases were excluded from this study. Mean age was 62±15 and 61% were males. DHCA was used in 104 patients (59%), antegrade cerebral perfusion (ACP) or retrograde cerebral perfusion (RCP) in 73 patients (41%). There was 27% reoperations: 32% in DHCA, 19% in ACP/RCP (p=0.09). Baseline patients’ characteristics were similar between groups.
Results
Overall in hospital mortality was 3%, in DHCA group 4% versus 3% in ACP/RCP group (p=0.7).
Cardiopulmonary bypass time was similar between groups. Arrest time and cross-clamp times were shorter in the DHCA group versus ACP/RCP group (15±9 vs. 24±15 and 75±38 vs. 97±54, both p<0.01). Major complications were similar between groups, except new dialysis that was more prevalent in the ACP/RCP (p<0.01). Stroke rates were 6% in the DHCA versus 4% in the ACP/RCP groups, P=0.7. Mean hospital duration, ICU time and ventilation time, were similar between groups.
Conclusions
Early outcome and neurological complications were comparable between DHCA without additional cerebral perfusion versus DHCA and antegrade or retrograde perfusion. DHCA can be done safely with excellent outcome in elective non-complex arch repair with arrest times lower than 25 minutes.
