[Selections of aortic reconstruction procedures and brain protection methods during aortic arch repairs; including mid-term survival and freedom from cerebral infarction].
Aortic reconstruction procedures and brain protection methods are very important among operative factors that have direct influence on surgical results. We nowadays use hypothermic circulatory arrest (HCA) with or without retrograde cerebral perfusion (RCP) as brain protection methods during hemiarch replacement (HAR) and selective cerebral perfusion (SCP) during total arch replacement (TAR) using 4-branched arch graft. The purpose of this study was to verify the appropriateness of this strategy. From April 1997 to August 2001, we performed 120 TAR assisted by SCP and 30 HAR assisted by HCA with or without RCP. Incidences of in-hospital death and postoperative neurological dysfunction were compared between the 2 groups. In-hospital deaths were 4 (3.3%) and 1 (3.3%), permanent neurological dysfunction were 3 (2.5%) and 1 (3.3%), temporary neurological dysfunction were 4 (3.3%) and 1 (3.3%), 3-year survival were 92 +/- 3% and 97 +/- 3% and cerebral infarctions after discharge were 2 and 0 in TAR and HAR, respectively. Appropriate selections of aortic reconstruction procedures and brain protection methods lead to good operative results in aortic arch repairs.