Improved results of atherosclerotic arch aneurysm operations with a refined technique

Objective: We sought to analyze the postoperative hospital mortality and postoperative neurologic dysfunction in patients who had total arch replacement for atherosclerotic arch aneurysms using our recent refined technique. Methods: Between June 1997 and April 2000, 50 consecutive patients underwent total arch replacement with an aortic arch branched graft for atherosclerotic arch aneurysms. Their mean age was 71 +/- 7 years (range, 57-87 years). Forty-eight (96%) patients were operated on electively, and the remaining 2 (4%) were operated on an emergency basis because of rupture of aneurysm. All operations were performed with hypothermic extracorporeal circulation, selective cerebral perfusion for cerebral protection during aortic arch repair, and systemic circulatory arrest during distal graft anastomosis. A total of 19 concomitant procedures were done in 17 patients. Mean selective cerebral perfusion time was 78.1 +/- 16.5 minutes. Results: Overall in-hospital mortality was 2% (95% confidence intervals, 0%-5.9%). On univariable analysis, permanent neurologic dysfunction was the only risk factor for in-hospital mortality. Postoperative temporary and permanent neurologic dysfunctions were 4% (95% confidence intervals, 0%-9.4%) and 4% (95% confidence intervals, 0%-9.4%), respectively. On univariable analysis, cardiopulmonary bypass time was the only risk factor for temporary neurologic dysfunction, and history of cerebrovascular disease was the only risk factor for permanent neurologic dysfunction. There was no significant correlation between selective cerebral perfusion time and temporary and permanent neurologic dysfunction. Conclusion: Integrated cerebral protective effect of antegrade selective cerebral perfusion and total arch replacement with an aortic arch branched graft could substantially reduce in-hospital mortality and postoperative neurologic dysfunction in patients with atherosclerotic arch aneurysms.