Risk analysis for aortic surgery using hypothermic circulatory arrest with retrograde cerebral perfusion

Background. Retrospective analysis of 144 patients undergoing aortic arch reconstruction using hypothermic circulatory arrest (HCA) with retrograde cerebral perfusion (RCP) for cerebral protection was performed. Methods. The diagnosis, procedure, and anatomic site of the arch anastomosis were analyzed to see if they were independent predictors of mortality or morbidity. In addition age, gender, HCA-RCP times, preoperative malperfusion (both treated and untreated), surgical status, and redo surgery status were also examined to determine their influence on the incidence of death and complications. Both multivariate and univariate analysis were performed using linear regression and cross-tabulation with either chi(2) or Fisher's exact test where appropriate. Results. Preoperative surgical status (emergent) and the presence of untreated preoperative malperfusion were the only variables that were significant independent predictors for mortality (p < 0.05). No variable was significant for the prediction of stroke or other complications. The severity of surgery had no bearing on the patient outcome. Conclusions. Complex aortic surgery using HCA-RCP can be performed with acceptable risk to the patients. (C) 1999 by The Society of Thoracic Surgeons.