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J Thorac Cardiovasc Surg 1998;115:129-133
© 1998 Mosby, Inc.
SURGERY FOR CONGENITAL HEART DISEASE |
From the Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan. Read at the Seventy-seventh Annual Meeting of The American Association for Thoracic Surgery, Washington, D.C., May 4–7, 1997.
Received for publication May 6, 1997; revisions requested June 17, 1997; revisions received Sept. 29, 1997; accepted for publication Sept. 30, 1997. Address for reprints: Yutaka Okita, MD, Department of Cardiovascular Surgery, National Cardiovascular Center 5–7–1, Fujishirodai, Suita, Osaka 565, Japan.
Objective: Our goal was to investigate factors for mortality and cerebral outcome in patients with aneurysm of the aortic arch.
Methods: From 1993 to 1996, 148 patients with aortic arch aneurysm underwent operations involving deep hypothermic circulatory arrest with retrograde cerebral perfusion. Age was 63.9 ± 11.6 years (mean ± standard deviation) and 52 patients were older than 70 years. Twenty-eight had acute aortic dissection. Twelve had ruptured aneurysms. Fourteen had redo operations. Seventy had aortic dissection. The aneurysms were caused by atherosclerosis in 123 patients and by other causes in 25. Median sternotomy was used in 92 and left thoracotomy in 56. Twenty-eight patients underwent replacement of the ascending aorta to the proximal arch, 62 had total arch replacement, 38 had distal arch replacement, 12 had simultaneous replacement of the distal arch and the descending aorta or thoracoabdominal aorta, and 8 had patch repair.
Results: Fifteen (10.1%) early deaths occurred. New stroke occurred in six (4.0%) patients and transient delirium in 37 (25.0%). The duration of deep hypothermic circulatory arrest plus retrograde cerebral perfusion was 49 ± 17 minutes, and it was more than 60 minutes in 36 patients. Patients awoke 7.5 ± 8.2 hours after the operation. Logistic regression analysis demonstrated that risk factors for mortality were ruptured aneurysm, chronic obstructive pulmonary disease, arterial cannulation in the ascending aorta, and stroke. Risks for stroke were ruptured aneurysm and replacement of the distal arch. Risks for delirium were age older than 70 years and atherosclerotic aneurysm. Duration of circulatory arrest plus cerebral perfusion did not correlate with length of time before the patient regained consciousness. No difference was found in mortality, stroke, and delirium between patients with and those without more than 60 minutes of circulatory arrest and cerebral perfusion.
Conclusion: Prolonged (>60 minutes) deep hypothermic circulatory arrest with retrograde cerebral perfusion was not a risk factor for mortality and stroke in patients who underwent surgery for aneurysms of the aortic arch. However, the prevalence of transient delirium necessitates further investigations.
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