Aortic Arch Replacement Using Selective Cerebral Perfusion: Three Years’ Experience

Background- The present study was conducted to report our clinical experience with aortic arch replacement using selective cerebral perfusion (SCP) to evaluate the safety and usefulness of this technique. Methods- From October 2003 to April 2007, 10 patients (mean age 51.2 years) underwent arch replacement for acute type A dissection involving the aortic arch. Operations were performed with hypothermic cardiopulmonary bypass using antegrade selective cerebral perfusion during the arch surgery. Seven patients (70%) have a history of hypertension. Six patients (60%) underwent total arch replacement and the other four (40%) had semiarch replacement. Associated coronary artery bypass graft surgery (CABG) was performed in 2 patients (20%). The mean follow-up period was 10.39 months (ranging from 1 to 42 months). Results- Mean aortic cross-clamp time, CPB time and partial circulatory arrest time with antegrade cerebral perfusion were 121.4 (95-165), 257.7 (230-290) and 16.5 (13-22) minutes, respectively. There were two hospital mortalities and one cerebral complication. All inhospital mortalities were in our five first cases, indicating perhaps a learning curve for this operation. During the follow-up period, no patient underwent reoperation because of recurrence of dissection. All surviving patients are still alive and free from any serious events at the time of this writing. Conclusions- Selective cerebral perfusion is a reliable technique for cerebral protection and it facilitates the complex and time-consuming total arch replacement (Iranian Heart Journal 2008; 9 (2):6-9).