Antegrade Cerebral Perfusion for Acute Type A Aortic Dissection in 120 Consecutive Patients

Background: Treatment of acute type A aortic dissection remains a surgical challenge because of prolonged operative times, bleeding complications, and a considerable risk of neurologic morbidity and mortality. The following study investigates clinical results after modification of perfusion technique for cardiopulmonary bypass as well as temperature management.

Methods: Between January 2000 and August 2006, 120 consecutive patients underwent repair of acute type A dissection. Selective antegrade cerebral perfusion through the right subclavian artery combined with mild systemic hypothermia (30 degrees C) was used in all patients.

Results: Mean cardiopulmonary bypass time was 144 +/- 53 minutes, and mean myocardial ischemic time was 98 +/- 49 minutes. Isolated cerebral perfusion was performed for 25 +/- 12 minutes. Mean core temperature amounted to 30.1 degrees +/- 2.2 degrees C. Chest tube drainage during the first 24 hours was 525 +/- 220 mL. Mean ventilation time was 54 +/- 22 hours. Elevation of serum lactate levels at 1, 12, and 24 hours postoperatively rose to 22 +/- 14, 18 +/- 11, and 19 +/- 8 mg/dL respectively. We observed new postoperative permanent neurologic deficits in 5 patients (4.2%) and TND in 3 patients (2.5%). The 30-day mortality rate was 5% (n = 6). After a mean follow-up period of 2.8 years, 104 patients (87%) were still alive.

Conclusions: Antegrade cerebral perfusion in combination with mild hypothermia offered sufficient neurologic protection in our patient cohort, provided adequate distal organ protection, and reduced perioperative complications in surgery for type A dissection. This perfusion strategy may help in reducing perioperative complications in this particular patient population.