Outcomes of aortic arch repair with extended (≥ 90 minutes) antegrade cerebral perfusion.

Objectives: To analyze outcomes with extended duration of antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) for total arch repair (TAR).

Design: Retrospective study of consecutive patients undergoing TAR with HCA and ACP. Patients were divided into group A (ACP ≥ 90 min, n = 12) and group B (ACP < 90 min, n = 17) and compared regarding in-hospital mortality and neurological complications (primary outcome measures) and major complications, biochemical markers of organ damage, and blood product use (secondary outcome measures). Complications were analyzed according to standards of the International Aortic Arch Surgery Study Group.

Results: Overall in-hospital mortality was 4/29 (14%); 1/12 (8.3%) in group A versus 3/17 (18%) in group B, p = 0.62. No grade-V (lethal) neurological complication occurred, but five patients (all in group B) had grade-IV neurological complications: one general and two each focal and spinal neurological deficit (p = 0.047, overall). Prevalence of grade-II (temporary) general neurological deficit was 17% (group A) versus 27% (group B), p = 0.66. None of the patients suffered ≥ grade-IV respiratory or renal complications. Other complications, biochemical markers, and blood product usage were not significantly different.

Conclusion: Outcomes in TAR with HCA and extended (≥ 90 min) three-vessel ACP were encouraging and could be contemplated with anticipated time-consuming TAR.