Evolution of cerebral perfusion techniques in type a aortic dissection surgery: a single center experience

• Published in: Perfusion Vol. 27; no. 5; pp. 363 - 370
• Main Authors: Salah, K, van Straten, AHM, Soliman Hamad, MA, ter Woorst, JF, Tan, MESH
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-09-2012; Sage Publications Ltd
• Subjects: Aneurysm, Dissecting - surgery; Cerebrovascular Circulation; Cohort Studies; Female; Hospital Mortality; Humans; Hypothermia, Induced - methods; Male; Middle Aged; Perfusion - methods; Survival Rate; Treatment Outcome; hypothermia; aortic dissection; cerebral protection
• ISSN: 0267-6591; 1477-111X
• DOI: 10.1177/0267659112448411

Background:
The purpose of this study was to investigate the effect of using antegrade selective cerebral perfusion (ASCP) with moderate hypothermia on hospital mortality after surgery for acute type A aortic dissection (AAAD).
Methods:
Between January 1998 and December 2008, 142 consecutive patients were operated on for AAAD. Patients were divided into two subgroups: the cohort of patients operated on from January 1998 until December 2003 (without ASCP) (P1998-2003, n=64) and the cohort operated on from January 2004 until December 2008 (with ASCP)(P2004-2008, n=78).
Results:
The difference in hospital mortality was statistically significant (P1998-2003: 42.2%; P2004-2008: 14.1%, p<0.0005). Survival rates were 51.6±6.2% vs. 75.1±5.5% and 45.9±6.2% vs. 69.7±7.3% for one and four years, respectively (p=0.001). Multivariate logistic regression analysis revealed that ASCP was the only independent protective factor of hospital mortality (p=0.047).
Conclusion:
In patients operated on for AAAD, antegrade selective cerebral perfusion with moderate hypothermia is a significant factor in decreasing hospital mortality.