Operation for type A aortic dissection: introduction of retrograde cerebral perfusion.

Circulatory support during operation for type A aortic dissection is controversial among many medical centers. In the last 21 years, 100 patients with type A aortic dissection underwent 102 operations including 2 reoperations, and 29 patients showed Marfan's syndrome. During operation, no cerebral perfusion technique was used through February 1985 (period I), antegrade cerebral perfusion was applied since March 1985 (period II), and retrograde cerebral perfusion was introduced in November 1990 (period III). Surgical results were compared among these subgroups. Operative mortality was 12.1% in 33 chronic and 57.1% in 7 acute patients in period I, 11.1% in 27 chronic and 54.5% in 11 acute patients in period II, and 6.7% in 15 chronic and 0% in 9 acute patients in period III (period II versus III; p = 0.04). Retrograde cerebral perfusion decreased permanent brain complications. The 5-year actuarial survival was 59.7% in period I and 63.2% in period II (not significant), and the 3-year survival of period III was 91.7%. Actuarial survival of period III was significantly higher than those of periods I and II (p < 0.05). Surgical repair of aortic arch with cerebral perfusion techniques reduced the residual aneurysms. These results show that surgical results of type A aortic dissection in this series improved with the introduction of retrograde cerebral perfusion and extended surgical procedures.