Abstract 16742: Determinants of Mortality And Neurological Outcome Following Treatment of Acute Type A Dissections Using Different Cerebral Protection Methods
Objective: To assess the efficacy and midterm results of different cerebral protection techniques in the treatment of acute type A aortic dissection.
Methods and results: Between 1993 and 2010, 329 patients(220 male, median age 59)undergoing replacement of the ascending aorta/arch with an open distal anastomosis were analyzed. Either hypothermic circulatory arrest(HCA) alone at 18 Degrees(n=116;35%) or in combination with retrograde cerebral perfusion(RCP) (n=120;36%) or antegrade cerebral perfusion(ACP) at 25 Degrees(n=93;29%) were used. Median circulatory arrest time was 29 minutes(4-145). Overall in-hospital mortality was 19% (63/329); 28%(32 pts) in the HCA group(25pts), vs.17% in the RCP group(21pts) vs. 11%(10pts) in the ACP group(p=0.02). Permanent neurological dysfunction(PND) occurred in 53 patients(16%), with no statistically significantly differences between the 3 groups.(25% in HCA vs.13% in the RCP vs.12% in the ACP group;p=0.13) Transient neurological dysfunctions(TND) were observed in 14 of the other 266 patients(5 %) with a trend towards improved clinical outcome with the use of ACP(10% in HCA group, vs.6 % in the RCP vs.2% in the ACP group;p=0.14). Multivariate analysis revealed that preoperative hemodynamic instability was the only statistically significant independent predictor of in-hospital mortality(odds ratio [OR] 5.24; 95% CI 2.6 - 10.5;p<0.001) and the only significant independent predictor of PND was the use of HCA alone(OR 2.52; 95% CI 1.35- 4.69;p=0.004). Overall long-term survival(mean follow up 65 months) was 76% at one year,68% at 5 years and 56% at 10 years with statistically significant differences between the three groups(p=0.03). ACP patients had 1,5 and 10 year survival rates of 86%, 81% and 74% respectively,in comparison to 74%, 66% and 52% in the RCP group and 68%, 65% and 55% in the HCA alone group. (Figure1)
Conclusion:The use of ACP confers mostly a survival benefit in the treatment of acute type A aortic dissections.
- © 2011 by American Heart Association, Inc.