Surgical treatment of aortic arch aneurysms using selective cerebral perfusion. Experience with 100 patients.

Hundred consecutive patients were operated on for aortic arch aneurysms between January 1986 and October 1993. All operations were performed with the aid of extracorporeal circulation, blood cardioplegia for myocardial protection, and selective cerebral perfusion (SCP) for protection of cerebral ischemia during aortic arch repair. Forty-four patients (44%) had an emergency operation because of frank or impending rupture of aneurysms or acute aortic dissection. Eighty-three patients (83%) underwent total arch replacement, and 54 had concomitant procedures including aortic valve resuspension, aortic valve replacement (AVR), composite graft replacement and coronary artery bypass grafting (CABG). The overall early (30-day) mortality rate was 16%. Multivariate analysis revealed, as significant risk factors, preoperative cardiopulmonary resuscitation, renal-mesenteric ischemia due to acute dissection, previous ascending aorta/arch operation and preoperative stroke. Of the 71 (71%) patients who were free of these risk factors, only one (1.4%) died. One patient (1%), who was preoperatively in shock state, had a distinct stroke. The present data suggest that SCP is a useful method for aortic arch aneurysm operation requiring complex repair of the aortic arch.