Arch replacement using antegrade selective cerebral perfusion for shaggy aorta

Abstract

Embolic stroke during arch replacement is a serious concern in patients with shaggy aorta. To evaluate shaggy aorta in patients who received total aortic arch replacement with antegrade selective cerebral perfusion utilizing axillary perfusion. Between January 2005 and December 2010, 63 patients underwent preoperative contrast-enhanced computed tomography scanning of the aorta to evaluate atheromatous plaque. We analyzed operative data to investigate which factors were associated with outcomes and survival. Shaggy aorta was found in 34 (54%) patients. There were 3 (5%) cases in the ascending aorta, 26 (41%) in the aortic arch, and 19 (30%) in the descending aorta. Operative mortality occurred in 1 (2%) patient. Although stroke occurred in 2 (3%) shaggy aorta patients, shaggy aorta was not associated with an increased likelihood of stroke (p = 0.4951). Survival was significantly lower in patients with shaggy descending aorta (p = 0.0411) and in patients >75-years old (p = 0.0200); these traits were identified as independent risk factors for late death (p = 0.0368 and p = 0.0100, respectively). We concluded that our perfusion technique protects patients with shaggy aorta against embolism, and that the survival is lower in patients with shaggy descending aorta.