Early clinical results of retrograde cerebral perfusion for aortic arch operations in Japan

Background. In Japan, retrograde cerebral perfusion (RCP) has been used for protection of the brain since 1986. The techniques vary by institution, and thus the optimum perfusion conditions have not yet been established. Methods. A survey of 49 institutions was performed to investigate the early results of RCP in Japan. There were 228 patients collected, 46 (20.2%) of whom sustained brain complications. Twenty-seven patients had permanent and 19, temporary neurologic dysfunction. There were 31 early deaths (13.6%) and an additional 14 hospital deaths (6.1%). Significant predictors of brain complications and mortality were evaluated by univariate analysis and multivariate analysis using stepwise logistic regression. Results. By multivariate analysis, preoperative cardiac arrest (odds ratio 8.901, p = 0.0004) and RCP duration longer than 60 minutes (odds ratio 3.234, p = 0.0352) were significant predictors of permanent neurologic dysfunction. Preoperative hemodynamic compromise (odds ratio 6.150, p = 0.0070), presence of preoperative neurologic symptoms (odds ratio 7.155, p = 0.0283), and left thoracotomy (odds ratio 2.37, p = 0.0335) were significant predictors of early death. Duration of RCP was the single RCP-related factor predictive of a brain complication (odds ratio 1.025 per minute, p < 0.0001). The incidence of permanent neurologic dysfunction was less than 10% when the RCP time was shorter than 60 minutes but increased abruptly when the RCP time exceeded 100 minutes, and it remained approximately 15% between 60 and 99 minutes. Conclusions. Less than 60 minutes of RCP can be tolerated with minimal risk of brain complication. Retrograde cerebral perfusion is one method of cerebral protection during circulatory arrest. This method is not the complete answer for brain protection, but, given specific guidelines, it may help prolong the safe time of circulatory arrest.