Antegrade selective cerebral perfusion during operations on the thoracic aorta: Factors influencing survival and neurologic outcome in 413 patients

被引:108
|
作者
Di Eusanio, M
Schepens, MAAM
Morshuis, WJ
Di Bartolomeo, R
Pierangeli, A
Dossche, KM
机构
[1] St Antonius Hosp, Dept Cardiopulm Surg, NL-3435 CM Nieuwegein, Netherlands
[2] Univ Bologna, Policlin S Orsola, Dept Cardiac Surg, Bologna, Italy
来源
关键词
D O I
10.1067/mtc.2002.124994
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: We retrospectively analyzed hospital mortality and neurologic outcome after operations on the thoracic aorta with the aid of antegrade selective cerebral perfusion to determine a predictive risk model. Methods: Between October 1995 and May 2001, 413 patients (mean age, 63.0 +/- 11.5 years) underwent operations on the thoracic aorta with antegrade selective cerebral perfusion. Indications for surgical intervention were acute type A dissection in 116 (28.1%) patients, degenerative aneurysm in 227 (55.0%) patients, and postdissection aneurysm in 70 (16.9%) patients. One hundred twenty-five (30.3%) patients were operated on urgently; concomitant procedures were performed in 171 (41.4%) patients. Mean cerebral perfusion time was 63.0 +/- 38.7 minutes (range, 16-220 minutes). Preoperative and intraoperative factors were evaluated by means of univariate and multivariate analysis to identify predictors of hospital mortality and neurologic outcome. Results: The hospital mortality was 9.4%. Stepwise logistic regression revealed urgency status (P = .000; odds ratio, 19.9) and recent history of a recent central neurologic event (P = .004; odds ratio, 8.0) to be independent determinants for hospital mortality. Temporary neurologic dysfunction occurred in 20 (5.1%) patients. Urgency status (P = .005; odds ratio, 7.5), history of a central neurologic event (P = .003; odds ratio, 8.6), and coronary artery bypass grafting (P = .019; odds ratio, 6.0) were independent determinants of temporary neurologic dysfunction. Urgency status (P = .003; odds ratio, 8.6) was the only independent determinant for permanent neurologic dysfunction, and it occurred in 15 (3.7%) patients. Conclusion: Antegrade selective cerebral perfusion is an effective method of brain protection. Cerebral perfusion times of longer than 90 minutes were not associated with an increased risk of hospital mortality or poorer neurologic outcome. Urgency status and recent history of central neurologic events were retained as important risk factors for hospital mortality and neurologic outcome.
引用
收藏
页码:1080 / 1086
页数:7
相关论文
共 29 条
  • [1] Antegrade selective cerebral perfusion during operations on the thoracic aorta: Our experience
    Di Bartolomeo, R
    Pacini, D
    Di Eusanio, M
    Pierangeli, A
    [J]. ANNALS OF THORACIC SURGERY, 2000, 70 (01): : 10 - 15
  • [2] Antegrade selective cerebral perfusion in operations on the proximal thoracic aorta
    Dossche, KM
    Schepens, MAAM
    Morshuis, WJ
    Muysoms, FE
    Langemeijer, JJ
    Vermeulen, FEE
    [J]. ANNALS OF THORACIC SURGERY, 1999, 67 (06): : 1904 - 1910
  • [3] Antegrade selective cerebral perfusion during operations on the thoracic aorta: Our experience - Commentary
    Kazui, T
    [J]. ANNALS OF THORACIC SURGERY, 2000, 70 (01): : 15 - 16
  • [4] Bilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta
    Dossche, KM
    Morshuis, WJ
    Schepens, MA
    Waanders, FG
    [J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2000, 17 (04) : 462 - 466
  • [5] Antegrade selective cerebral perfusion during surgery of the thoracic aorta: risk analysis
    Di Bartolomeo, R
    Di Eusanio, M
    Pacini, D
    Pagliaro, M
    Savini, C
    Nocchi, A
    Pierangeli, A
    [J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2001, 19 (06) : 765 - 770
  • [6] Bilateral antegrade selective cerebral perfusion during surgery on the proximal thoracic aorta - Conference discussion
    Minale, C
    Dossche
    Minale
    Jansen, E
    Okita, Y
    [J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2000, 17 (04) : 466 - 467
  • [7] Antegrade selective cerebral perfusion in thoracic aorta surgery: safety of moderate hypothermia
    Pacini, Davide
    Leone, Alessandro
    Di Marco, Luca
    Marsilli, Daniele
    Sobaih, Fedaa
    Turci, Simone
    Masieri, Valeria
    Di Bartolomeo, Roberto
    [J]. EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY, 2007, 31 (04) : 618 - 622
  • [8] Usefulness of antegrade selective cerebral perfusion during aortic arch operations
    Kazui, T
    Yamashita, K
    Washiyama, N
    Terada, H
    Bashar, AH
    Suzuki, T
    Ohkura, K
    [J]. ANNALS OF THORACIC SURGERY, 2002, 74 (05): : S1806 - S1809
  • [9] Brain monitoring during retrograde cerebral perfusion in operations on the thoracic aorta
    Ehrlich, M
    Grabenwoger, M
    Luckner, D
    CartesZumelzu, F
    Simon, P
    Grubhofer, G
    Lassnig, A
    Laufer, G
    Wolner, E
    Havel, M
    [J]. CEREBRAL PROTECTION IN CEREBROVASCULAR AND AORTIC SURGERY, 1997, : 219 - 223
  • [10] Surgery of the thoracic aorta using selective antegrade cerebral perfusion: A 3-years experience
    Di Bartolomeo, R
    Di Eusanio, M
    Pagliaro, M
    Pilato, E
    Settepani, F
    Martin, S
    Pierangeli, A
    [J]. 49TH INTERNATIONAL CONGRESS OF THE EUROPEAN SOCIETY FOR CARDIOVASCULAR SURGERY, 2000, : 93 - 97