Abstract
Hypothermic circulatory arrest (HCA), antegrade cerebral perfusion (ACP), and retrograde cerebral perfusion (RCP) are three well-described techniques for cerebral protection in aortic arch surgery. However, the associated peri-operative outcomes in the currently published are conflicting. Furthermore, long-term survival remains largely unexplored in this population. Therefore, the objective of this study is to review the population-based experience in British Columbia with three techniques of cerebral protection in aortic arch surgery, with an emphasis on long-term survival. The prospectively maintained provincial cardiac surgery database was retrospectively interrogated. All patients undergoing aortic arch surgery requiring HCA, ACP+/−HCA, or RCP+/−HCA between 1993-2010 were identified and baseline characteristics were summarized for the three groups of patients. The in-hospital rate of stroke, 30-day mortality, and successful discharge home were compared across the three cerebral protection groups using the Chi-squared test. Kaplan-Meier analysis was performed to determine long-term survival at 17 years, and results were compared across the three groups using the Log Rank test. From 1993-2010, 599 patients underwent aortic arch surgery at 4 hospitals in British Columbia. The mean age was 63 years and the majority of patients (63%) were male. Twenty-two percent of patients received HCA alone, 62% of patients received ACP+/−HCA, and 16% of patients received RCP+/−HCA. Baseline characteristics were similar across the three groups, except patients receiving ACP were less likely to have undergone emergent surgery and were more likely to have received surgery after 2001. Peri-operative outcomes and survival rates are listed in the Table.Tabled 1 Antegrade and retrograde cerebral perfusion are associated with improved in-hospital outcomes and mid-term survival, compared to hypothermic circulatory arrest alone following aortic arch surgery. However, long-term survival is superior among patients receiving antegrade cerebral perfusion, compared to the other two modes of cerebral protection.
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