Continuous retrograde cerebral perfusion: Brain protection during aortic surgery with hypothermic circulatory arrest

Clinical data were retrospectively collected for 125 consecutive patients who underwent aortic arch surgery using continuous retrograde cerebral perfusion (CRCP) from March 1988 to December 1998 at Tenri Hospital. Altogether, 58 patients (46%) were operated on for dissection, 63 patients (50%) for atherosclerotic aneurysm, 3 for iatrogenic aortic injury, and 1 for a graft infection. A total of 100 patients were operated on via a median sternotomy and the remaining 25 patients for a distal arch aneurysm through a left lateral thoracotomy. Hospital mortality was 6% (eight patients). A total of 23 patients (18%) had transient (n = 11) or permanent (n = 12) postoperative neurological disturbance; four of them in a vegetative state died postoperatively. CRCP times ranged from 5 to 93 min (median 41 min). CRCP duration, age of the patient, and the type of aortic disease did not contribute to stroke or death. The sole predictor of a postoperative neurological event or hospital death was rupture of the aneurysm (P < 0.001). The simplicity of CRCP with a highly favorable impact on stroke rate and survival after aortic arch surgery, regardless of the periods of hypothermic circulatory arrest, justifies continued clinical use in all patients undergoing aortic arch surgery.