Neurocognitive functions after aortic arch repair with right brachial artery perfusion.

Background: Satisfactory neurologic outcome following aortic arch repair through right brachial artery perfusion is well established. However, how neurocognitive functions are affected following selective cerebral perfusion, still needs to be elucidated.

Methods: In a period between April 2002 and March 2003, 22 patients (19 male, 3 female, with a mean age of 46.8 +/- 12; range: 26 to 70 years old), underwent aortic arch repair using right brachial artery low flow (8 to 10 mL x kg(-1) x min(-1)) selective antegrade cerebral perfusion under moderate hypothermia (26 degrees C). There were 6 Stanford type-A dissections and 16 ascending aortic aneurysms. All patients were evaluated preoperatively and postoperatively (at seventh day and second month) for neurocognitive functions.

Results: There was no operative mortality. The average cardiopulmonary bypass time was 115.0 +/- 24.2 minutes and the average antegrade cerebral perfusion time was 29.8 +/- 7.1 minutes (19 to 38 minutes). No major neurologic deficit was observed in the postoperative period. In terms of neurocognitive test results, between the preoperative and postoperative assessments for both hemispheric cognitive functions no deterioration was detected.

Conclusions: The low-flow selective antegrade cerebral perfusion technique through the right brachial artery may safely be used for the great majority of patients undergoing aortic arch repair without causing deteriorations in neurocognitive functions.