Medium-term results after surgery for aortic arch aneurysm with hypothermic cerebral perfusion

Abstract

We have used two techniques of hypothermic cerebral perfusion (CP) for the surgical treatment of aortic arch aneurysm in the last 10 years. Between March 1985 and December 1993, 83 patients underwent surgery for aortic arch aneurysm. Fifty-one cases had aortic dissection (AD) in the transverse arch and/or its branches, and 32 cases showed true aneurysm (TA) of the aortic arch. In those 83 patients, 37 cases received antegrade CP and 46 cases underwent retrograde CP. Surgical results were compared among the groups by Kaplan-Meier actuarial method and Cox-Mantel statistical analysis. The early mortality after surgery for aortic arch aneurysm was 11.8% in the AD group and 21.9% in the TA group. The early mortality was 21.6% with antegrade CP and 10.9% with retrograde CP. The 6-year actuarial survival rate was 71.7% in the TA group and 67.1% in the AD group. In the AD group, the 3-year survival rate was 93.9% with retrograde CP and 61.1% with antegrade CP (P < 0.005). In the TA group, the 3-year survival rate was similar for antegrade CP (73.3%) and retrograde CP (69.2%). These results suggest that current surgical results of aortic arch aneurysm with hypothermic CP are acceptable and the retrograde CP technique might be recommended, especially for surgery of aortic arch aneurysm with AD.

Fluid-structure interaction in layered aortic arch aneurysm model: assessing the combined influence of arch aneurysm and wall stiffness

“…A dissection plane that separates the intima from the overlying adventitia along a variable length of the aorta is created within the media [35,36]. Many aortic dissection cases with aortic aneurysm were found [2][3][4]. The corresponding finding in this study is the stresses are higher in the media and the aortic arch aneurysm increases the stresses.…”

“…As observed clinically, many aortic dissection cases with aortic aneurysm were found in the literature [2,3,4], typically patients with aortic arch aneurysm. Our results indicate the aortic arch aneurysm increases stresses on aortic wall, and it may provide important information for understanding the mechanical behaviour of aortic arch aneurysm.…”

“…It was reported that aortic dissection originated in a distal aortic arch aneurysm [34]. With the combined effects of aneurysm and wall stiffness, it is possible that patients with aortic aneurysm, especially aortic arch aneurysm [4], are prone to aortic dissection. In this study, stresses are found to be higher in the media, and reach peak values in the media near the adventitia at inflection points, and medial stiffening increased the stress in media and peak stress value.…”

“…A classic aortic dissection begins with a laceration of the aortic intima and inner layer of the aortic media, forming an entrance tear, which allows entering blood to split the aortic media. Many aortic dissection cases with aortic aneurysm were found everywhere in the literature [2,3,4]. In Mehta's [3] paper, of 383 patients with acute type B dissection, 18.2% had prior aortic aneurysm.…”

“…In Mehta's [3] paper, of 383 patients with acute type B dissection, 18.2% had prior aortic aneurysm. Among the 83 patients of aortic arch aneurysm in Kitamura's [4] paper, 51 cases had aortic dissection. The patients with aortic aneurysm, especially aortic arch aneurysm [4], are prone to aortic dissection.…”