Original article: cardiovascularProspective comparative study of brain protection in total aortic arch replacement: deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion
Section snippets
Patients and methods
From June 1, 1997 to April 9, 1999, 84 patients had a total replacement of the transverse aortic arch in the National Cardiovascular Center, Osaka, Japan. Seventeen patients who underwent an emergent surgery because of acute aortic dissection or rupture of the aneurysm were excluded. Two patients who had a total aortic arch replacement via a left thoracotomy were also excluded from the analysis. Sixty consecutive patients who had a total arch replacement via a midsternotomy on an elective basis
Results
Total duration of the operation (RCP 365 ± 131, SCP 467 ± 218, p = 0.03 minutes; p = 0.03) and bypass time (175 ± 58, 215 ± 83 minutes; p = 0.03) were significantly longer in the SCP group. Duration of cardiac ischemia (99.8 ± 44.3, 106 ± 58 minutes; p = 0.6) and of circulatory arrest of the lower body (44.3 ± 13.9, 54.1 ± 26.3 minutes; p = 0.07) were similar. In the RCP group, the duration of the total circulatory arrest was 44.3 ± 13.9 minutes, and the duration of RCP was 33.1 ± 11.4 minutes.
Comment
Although brain complication remains a rare event after cardiac surgery, it is a major cause of postoperative mortality and morbidity in thoracic aortic surgery [2]. An alarming prevalence (1% to 83%) 3, 4 of postoperative neuropsychological dysfunction has been reported after cardiopulmonary bypass. Improvement of methods to assess the postoperative neuropsychiatric status has been achieved recently; however, there is no simple method to determine the incidence or severity of brain injury after
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