Abstract 2683: Ascending and Transverse Aortic Arch Repair: The Impact of Retrograde Cerebral Perfusion
Introduction: Since its introduction, the benefit of retrograde cerebral perfusion with profound hypothermic circulatory arrest has been subject to much debate. We examined our experience with ascending and transverse arch repairs in order to determine the impact of retrograde cerebral perfusion on stroke and mortality.
Methods and Results: Between 8/1991 and 11/2006, we performed 1011 consecutive repairs of the ascending and transverse aortic arch. Profound hypothermic circulatory arrest with retrograde cerebral perfusion was used in 81% (823/1011) of cases. 61% were men (621/1011); median age was 64 years (range 16 –93 years). Peri-operative variables were evaluated using univariate and multivariable analysis for mortality and stroke. Operative mortality was 10.9% (110/1011). Stroke occurred in 2.5% (25/1011) of patients. Univariate risk factors for mortality were emergency status (p<0.0001), acute dissection (p<0.005), coronary artery disease (p<0.04), age (p<0.002), bypass time (p<0.0001), cross-clamp time (p<0.0008), circulatory arrest time (p<0.0001), and glomerular filtration rate (GFR) (p<0.0001). Univariate risk factors for stroke included emergency status (p<0.02), history of cerebrovascular disease (p<0.02), and cross-clamp time (p<0.04). By multivariable analysis, independent risk factors for mortality were bypass time (p<0.0001), emergency status (p<0.002), and GFR (p<0.0001), and for stroke were emergency status (p<0.004) and hypertension (p<0.01). Retrograde cerebral perfusion was protective against mortality and stroke on univariate and multivariable analysis.
Conclusions: The use of retrograde cerebral perfusion with profound hypothermic circulatory arrest is associated with a reduction in mortality and stroke. The use of retrograde cerebral perfusion remains warranted during repairs of the ascending and transverse aortic arch.