Di Marco Luca, Berardi Marianna, Murana Giacomo, Leone Alessandro, Botta Luca, Amodio Ciro, Bacchi Reggiani Maria Letizia, Di Bartolomeo Roberto, Pacini Davide
Division of Cardiac Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.
Asian Cardiovasc Thorac Ann. 2021 Jul 6:2184923211028782. doi: 10.1177/02184923211028782.
The introduction of selective antegrade cerebral perfusion technique as method of cerebral protection improved the outcome of open arch surgery. The aim of this study was to report early outcomes using this technique.
Between 1997 and 2017, data were collected retrospectively for all patients who underwent surgical replacement of the aortic arch using selective antegrade cerebral perfusion ( = 938). To confirm the effectiveness of this cerebral protection method, early outcome and results were evaluated.
The incidence of postoperative permanent neurological dysfunction was 6.4%. Overall hospital mortality was 11.9% ( = 112). On multivariable analysis, age >75 years, female gender, euroscore at increment of 1 point, chronic renal failure, extension of thoracic aorta replacement and CPB time emerged as independent risk factors for hospital mortality. The mid-term survival at 1, 5, 10 and 15 years was 92%, 78%, 60% and 49%, respectively. The competing risk analysis for permanent neurological dysfunction and aortic reoperations was performed excluding the patients who died during the hospital stay. The cumulative incidence of permanent neurological dysfunction and aortic reoperations was 2% at 3 years, 3% at 5 years, 6% at 10 years, 12% at 3 years, 15% at 5 years and 19% at 10 years, respectively.
From the early 90s to the present day, the selective antegrade cerebral perfusion has confirmed to be a useful and "safe" method of brain protection in aortic arch surgery in terms of postoperative neurological complications.
选择性顺行性脑灌注技术作为一种脑保护方法的引入改善了主动脉弓开放手术的预后。本研究的目的是报告使用该技术的早期预后情况。
回顾性收集1997年至2017年期间所有采用选择性顺行性脑灌注进行主动脉弓手术置换的患者的数据（n = 938）。为证实这种脑保护方法的有效性，对早期预后和结果进行了评估。
术后永久性神经功能障碍的发生率为6.4%。总体医院死亡率为11.9%（n = 112）。多变量分析显示，年龄>75岁、女性、欧洲心脏手术风险评估系统（EuroSCORE）每增加1分、慢性肾功能衰竭、胸主动脉置换范围扩大和体外循环时间是医院死亡率的独立危险因素。1年、5年、10年和15年的中期生存率分别为92%、78%、60%和49%。对永久性神经功能障碍和主动脉再次手术进行竞争风险分析，排除住院期间死亡的患者。永久性神经功能障碍和主动脉再次手术的累积发生率在3年时为2%，5年时为3%，10年时为6%，13年时为12%，15年时为15%，10年时为19%。
从90年代初至今，就术后神经并发症而言，选择性顺行性脑灌注已被证实是主动脉弓手术中一种有用且“安全”的脑保护方法。
