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Eur J Cardiothorac Surg 2000;17:462-467
© 2000 Elsevier Science NL
a Department of Cardiopulmonary Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
b Department of Clinical Perfusion, St. Antonius Hospital, 3435 CM Nieuwegein, The Netherlands
Corresponding author. Tel.: +31-30-609-2047; fax: +31-30-609-2120
e-mail: dossche{at}planet.nl
Objective: To assess risk factors for hospital death and neurologic outcome after surgery on the proximal thoracic aorta using moderate hypothermic circulatory arrest and bilateral antegrade selective cerebral perfusion. Methods: From October 1995 through June 1999, 163 patients with a mean age of 63±11 years underwent surgery using bilateral antegrade selective cerebral perfusion. Degenerative aneurysms (55%) and acute type A dissection (28%) were the predominant indications for operation. Forty-six (28%) operations were considered as emergency procedure. Twenty-four (15%) procedures were reoperations. Results: Mean ASCP time was 48±20 min. Hospital mortality was 8.6% (n=14; 70% confidence limit (CL): 6.4–10.8%). Univariate risk factors for hospital mortality were acute type A dissection (P=0.003), central neurologic damage <24 h before the operation (P=0.000), preoperative hemodynamic instability (P=0.034), and rethoracotomy for any cause (P=0.036). Logistic regression analysis identified central neurologic damage <24 h (P=0.006, odds ratio 14) as an independent risk factor. Temporary neurologic damage occurred in 3.8% (n=6; 70% CL: 2.3–5.3%) of patients. Logistic regression analysis indicated preoperative hemodynamic instability (P=0.003, odds ratio 13) as an independent risk factor. Perioperative permanent central neurologic damage was reported in another 3.8% (n=6; 70% CL: 2.3–5.3%) patients. Acute type A dissection (P=0.018, odds ratio 8) and the non-use of a midline sternotomy (P=0.049, odds ratio 8) were retained as independent risk factors. Conclusion: Hospital mortality and perioperative neurologic complications are not significantly influenced by the duration of antegrade selective cerebral perfusion. Overall complication rate is low.
Key Words: Antegrade selective cerebral perfusion • Proximal thoracic aorta • Risk factors • Mortality • Morbidity
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