Integrated Total Arch Replacement Using Selective Cerebral Perfusion: A 6-Year Experience

Background The purpose of this study was to evaluate the recent outcome of integrated total arch replacement using antegrade selective cerebral perfusion with right axillary artery perfusion. Methods Between 2000 and 2005, 305 patients underwent elective total arch replacement for arch or distal arch aneurysm using a Dacron (DuPont, Wilmington, DE) quadrifurcated prosthesis through a median sternotomy. There were 34 dissecting and 271 nondissecting aneurysms. Brain protection was standardized using antegrade selective cerebral perfusion with right axillary artery cannulation at 20° to 28°C. Risk factors for early mortality and neurologic complications were investigated using multivariate logistic regression analyses. Results The durations of hypothermic circulatory arrest, myocardial ischemia, selective cerebral perfusion, cardiopulmonary bypass, and surgery were 60.9 ± 16.8, 125.2 ± 39.3, 150.1 ± 39.0, 229.8 ± 91.4, and 466.4 ± 175.8 minutes, respectively. Seven patients died, for a 2.3% early mortality. Permanent neurologic dysfunction developed in 5 patients (1.6%), and temporary neurologic dysfunction in 20 (6.6%). The mid-term survival rate was 94.6% ± 1.5% at 3 years. On multivariate analyses, prolonged surgery was a risk factor for early mortality. Preoperative cerebral hypoperfusion was a significant determinant for temporary neurologic dysfunction and male gender for permanent neurologic dysfunction. Conclusions Integrated total arch replacement using antegrade selective cerebral perfusion with right axillary artery cannulation yields a favorable outcome with low mortality and cerebral morbidity rates.