Repair of ascending and transverse aortic arch

Abstract

Objectives: This is a report to update our experience with repairs of the ascending and transverse arch, with an emphasis on the protective measures, including retrograde cerebral perfusion and blood flow and neurologic monitoring.

Methods: Retrospective data were collected from January 1991 to February 2010, and analysis was conducted on 1193 patients who had aneurysms involving the ascending aorta and arch.

Results: The 30-day mortality rate was 9.3%, but with a normal glomerular filtration rate, the mortality rate was 3%. In univariate analysis of the risk factors for death, the factors were advancing age of greater than 72 years (mortality, 14.8%; P = .002), the presence of coronary artery disease (mortality, 13.5%; P = .02), aortic pathology of acute dissection (mortality, 13.9%; P = .004), the emergency nature of the operation (mortality, 16.1%; P = .0001), and renal function in the lowest 3 quartiles of glomerular filtration rate (mortality, 6.9%, 10%, and 18.3%; P = .03, .0005, and .0001, respectively, with decreasing glomerular filtration rate). The highest quartile for pump time (>179 minutes) had a mortality rate of 18.1% (P = .0001). The overall stroke rate was 3%. In univariate analysis of risk factors for stroke, the stroke rate was 2.8% with and 4.2% without retrograde cerebral perfusion (P = .30), but when circulatory arrest time exceeded 40 minutes, the stroke rate was 1.7% with and 30% without retrograde cerebral perfusion (P = .002). Risk factors included age greater than 62 years (stroke rate, 4%; P = .04), hypertension (stroke rate, 3.7%; P = .03), emergency operations (stroke rate, 4.9%; P = .04), and glomerular filtration rate of less than 56 (stroke rate, 4.3%; P = .05). In multiple logistic regression for risk factors for stroke, age was associated with an odds ratio of 1.04 (P = .008), and emergency conditions had an odds ratio of 2.17 (P = .03).

Conclusions: Retrograde cerebral perfusion was associated with a trend toward a reduced incidence of hospital mortality and, in patients receiving prolonged hypothermic circulatory arrest, a reduced incidence of stroke.