Cerebral complications associated with selective perfusion of the arch vessels

Abstract

Background: Few studies have determined risk factors for postoperative cerebral complications associated with surgery of the aortic arch using selective cerebral perfusion.

Methods: Between November 1992 and December 1998, 113 patients underwent aortic arch repair combined with selective cerebral perfusion. For each patient, three arch vessels were perfused using a single roller pump at a rectal temperature of 23 degrees C.

Results: Among the 108 patients who underwent postoperative neurologic assessment, 25 patients (23%) suffered from cerebral complications. Five patients (5%) suffered from transient neurologic disturbance and 17 patients (16%) suffered from stroke, and 7 patients (7%) of the preceding 17 patients had residual neurologic disturbance upon discharge. Three patients (3%) with either preoperative coma (n = 1) or post bypass cardiac arrest (n = 2) sustained severe global cerebral dysfunction. The occurrence of cerebral complications was not related to cerebral perfusion time. Independent risk factors for cerebral complications included a history of cerebrovascular disease, perioperative shock, distal anastomosis below the left pulmonary artery, malperfusion of extremities, and older age (> 60 years).

Conclusions: Although high-level brain function was well preserved in most patients, the incidence of stroke when using current selective cerebral perfusion techniques is still high.