J Korean Soc Vasc Surg.  2003 May;19(1):83-89.

Open Distal Anastomosis in Retrograde Cerebral Perfusion for the Repair of Type a Ascending Aortic Dissection: Report of 11 Cases

• Lee HR
• Chung SW
• Kim JW

Abstract

BACKGROUND
Type A ascending aortic dissection, either acute or chronic, requires surgical treatment to prevent death from proximal aortic rupture or malperfusion. The application of deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP), which has originally been used for the cerebral protection during aortic arch surgery, to apply to type A ascending aortic dissection for the open distal anastomosis has been suggested. A retrospective study was conducted to evaluate the efficacy of DHCA with RCP in patients with type A aortic dissection. METHOD: From May 1998 to April 2002, eleven patients (7 men and 4 women; mean age=55.4 years) underwent repair of type A aortic dissection (9 acute and 2 chronic). All patients underwent resection and graft replacement of the ascending aorta and/or aortic arch. Open distal anastomosis was performed under DHCA (less than 19oC) with RCP, while the retrograde flow rate through the superior vena cava ranged from 200 to 500 ml/minute, to maintain internal jugular venous pressure between 15 and 25 mmHg. RESULT: Mean DHCA/RCP duration was 49.2 (27~85) minutes. Postoperatively, three patients died of arch rupture, right ventricular failure, and brain edema, and operative mortality was 27.3%. Eight patients survived and recovered their consciousness in 3 to 70 hours (mean, 11.6 hours) after operation. Among the eight patients whose DHCA/RCP duration was longer than 40 minutes, six patients survived with little neurological complications. During the follow-up period (mean, 22.8 months), one patient who underwent composite valve graft replacement died of ventricular tachyarrhythmia, However, the remaining seven patients were free from major events.
CONCLUSION
This limited data indicates that RCP can provide an improved cerebral protection, by extending the safe time limit of DHCA, as well as an open distal anastomosis without aortic cross-clamping for the repair of type A aortic dissection.

Keyword

Aortic dissection; Cerebral perfusion

MeSH Terms

Aorta
Aorta, Thoracic
Aortic Rupture
Brain Edema
Circulatory Arrest, Deep Hypothermia Induced
Consciousness
Female
Follow-Up Studies
Humans
Male
Mortality
Perfusion*
Retrospective Studies
Rupture
Tachycardia
Transplants
Vena Cava, Superior
Venous Pressure