Retrograde Cerebral Perfusion for Aortic Arch Surgery in Octogenarians

Abstract

We reviewed our surgical management of aortic arch aneurysms in 11 octogenarians. Seven operations (63.6%) were performed on an emergency basis for ruptured atherosclerotic aneurysm in 5 cases and for acute dissection in 2. Deep-hypothermic circulatory arrest, continuous retrograde cerebral perfusion, and open aortic anastomosis were employed routinely for brain protection during aortic arch replacement. There was one intraoperative death due to hemorrhage. One survivor died of bowel necrosis 47 days postoperatively and another suffered sudden death 5 months postoperatively. Both of these patients had been treated for a ruptured aneurysm and had suffered from postoperative neurological deficit. There were 2 late deaths due to unrelated events: subarachnoid hemorrhage and hepatic failure. The surgical outcomes were considered satisfactory, except in emergency cases of ruptured aneurysm where there was a high mortality and neurological morbidity. It is recommended that arch aneurysms at risk of rupture should be repaired electively before rupture, even in octogenarians, using deep-hypothermic circulatory arrest, continuous retrograde cerebral perfusion, and open aortic anastomosis.