Background: This study aimed to determine if the routine use of unilateral antegrade cerebral perfusion during repair of acute type A aortic dissection can eliminate the need for intraoperative neurophysiologic monitoring.

Methods: Between September 2000 and December 2009, 66 consecutive patients with acute type A aortic dissection underwent surgical repair in our clinic. In 57 patients (86.4%), arterial perfusion was provided through a right axillary artery cannula and in the remaining nine patients (13.6%) the arterial perfusion site was the femoral artery.

Results: Postoperative hospital mortality was 13.6% (n=9). Postoperative hemorrhage or tamponade requiring resternotomy occurred in seven patients (10.6%). Nine patients (13.6%) required postoperative inotropic support. Postoperative atrial fibrillation was observed in six patients. Mean intensive care unit stay and hospital stay were 5.1±4.4 days (range, 2 to 26 days) and 10.8±8.9 days (range, 7 to 60 days), respectively. Mean extubation time was 15.4±13.9 hours (range, 7 to 74 hours). One of the surviving patients experienced new transient neurological deficits in the postoperative period.

Conclusion: Unilateral antegrade selective cerebral perfusion techniques may provide reliable brain protection and reduce cerebral complication rates without the use of routine cerebral monitoring devices, even for longer periods of circulatory arrest during surgery of acute type A aortic dissection.

Keywords : Anaesthesia; aortic rupture; brain protection; cerebral perfusion; surgery