J Korean Med Sci.  2009 Oct;24(5):807-811. 10.3346/jkms.2009.24.5.807.

Unilateral Antegrade Selective Cerebral Perfusion in Aortic Surgery: Clinical Outcomes at Different Levels of Hypothermia

• Lee JH
• Chung CH
• Kang JK
• Choo SJ
• Song H
• Lee JW

• KMID: 1781998
• DOI: http://doi.org/10.3346/jkms.2009.24.5.807

Abstract

Although unilateral antegrade selective cerebral perfusion (UASCP) is considered a safe cerebral protection strategy during aortic surgery, an optimum temperature remains to be defined. This study compared outcomes in patients undergoing UASCP at either <24degrees C or > or =24degrees C. Between 2000 and 2007, 104 consecutive patients underwent aortic surgery using UASCP. Patients were divided into two groups according to systemic temperature: group A comprised 64 patients undergoing deep hypothermia (<24degrees C); and group B comprised 40 patients undergoing moderate hypothermia (> or =24degrees C). Both groups were similar in terms of the extent of aortic replacement and mean UASCP time. The total cardiopulmonary bypass time and aortic cross clamp time were longer in group A. Both groups were similar in terms of 30-day mortality rate (9.4% group A, 10.0% group B), and in terms of temporary (6.7% group A, 7.7% group B) and permanent (11.3% group A, 2.6% group B) neurological deficits. Multivariate analysis showed preoperative shock status was a risk factor for in-hospital mortality, and a preoperative history of a cerebral incident was a risk factor for permanent neurological deficit. UASCP under moderate hypothermia is a relatively safe and effective cerebral protective strategy during aortic surgery.

Keyword

Aorta, Thoracic; Cerebrovascular Circulation; Hypothermia

MeSH Terms

Aged
Aorta, Thoracic/surgery
Aortic Diseases/mortality/pathology/*surgery
Body Temperature
Cardiopulmonary Bypass/methods
*Cerebrovascular Circulation
Female
Hospital Mortality
Humans
*Hypothermia, Induced
Magnetic Resonance Angiography
Male
Middle Aged
Reperfusion/methods
Risk Factors
Shock/complications
Stroke/complications
Treatment Outcome

Figure

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  Fig. 1 Postoperative brain magnetic resonance angiography showing complete obstruction of the right internal carotid artery.

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